Scary BCBS info

I just read some info on the board that BCBS was not doing WLS anymore as of 2006. Please tell me that I read wrong or that it was wrong info. I have BCBS PPO of Mass and I am nearing the end of the process (just need to see the psyc. once more than onto the surgeon). It would be utterly outrageous if I went through this process and than they no longer cover it in the space of a few months. I am feeling really scared. Does anyone have any info on this?? HELP.

Kathleen, I would just call Blue Cross (the number on the card) and they will tell you if it is covered. They said the same thing in 2004, that it would no longer be covered in 2005, and it was. My booklet from BC said it was not covered, and I had no problem at all getting approved. Don't sweat it until you have to. Good luck, Carrie

Thanks Carrie

I got something from BCBS (as "administrator" of our plan - we're self-employed) about them re-evaluating WLS and only paying at certified institutions. It's part of a push here in Mass to only "certify" hospitals that do more than 100 WLS a year and a bunch of other criteria. It's one of those things that sounds good on the surface but is all about denying care *sigh*. Anyway, the memo from BCBS said there wouldn't be significant changes (at least in terms of certification****il 2007 but they were starting to give admins the heads-up. Let us know if you hear more from them... Kim

Yes, my mom said something about that, WLS could only be done at a hospital listed as a "Center of Excellence," but there are a lot to choose from. I know she mentioned Brigham & women's (where I went) and UMass Worcester were on the list.

I have a slight difference of opinion with you, Kim, about the reason behind them "certifying" hospitals for WLS. The Dept. of Public Health has established recommendations for minimum hospital/surgeon experience with WLS and a recent report showed that there are a number of programs falling WAY short of what DPH recommends for patient safety. Studies have clearly showed that the more surgeries a hospital and surgeon do the better the patients do (less complications, etc.) so "certifying" hospitals IMO isn't necessarily a way to deny care. JMO, Caeli

I'd be very surprised. They were wonderful. I read all the posts about people having a tough time with their insurance. BCBS was such a great support before/during/and after my surgery. I can't imagine they would stop. My life is so improved because of the surgery. I would have used BCBS soo much more over the next 30 years and I'm sure at increasing degrees. Financially, they would be crazy not to approve this surgery. I would just call and ask. Good luck. Maisy

Hello, I have just been approved by BCBS Hmo Blue on 1/9/06. It only took them four business days to approve me. I am going thru Saint Memorial Medical Center in Lowell, and when I told them what kind of insurance I had, they told me I should have no problem. So I would call them, each case is as individual as we are. Rumors are rumors. Keep praying and leave it in god's hands. Good Luck.

I have BCBS PPO and what you heard must be wrong. I was approved in a little less than 72 hours. Good luck