State of Oregon Employees! COVERAGE IN 2006!!!!!

I just read the PEBB newsletter tonight and it looks like there is coverage for state employees FINALLY for 2006! Those who had Kaiser had coverage if your bmi was over 50, but those out of the Portland/Salem area were left out. Now all plans will cover this I guess (I haven't seen the details). The requirements are that your bmi is over 35 (wow!!) and you have diabetes. There is more to it, but this is a HUGE victory for state employees and I am just jazzed. Miffed that it had to come too late for me since I went self-pay to Mexico, but just thrilled for all the rest of the state workers out there who need this benefit!!! Dina

I'm not fully understanding your message. Are you saying that Oregon State Employees are now covered with BCBS? Is there somewhere I can verify this, because I was about to switch to Kaiser during open enrollment, but I don't want to if I don't have to. Thanks. Vikky

It was in the PEBB newsletter this month where they stated the coverage will be for 2006 for ALL plans, not just Kaiser. Should have all the info in time for open enrollment... Dina

I AM NOT SURE WHERE YOU GOT YOUR INFO, MAYBE YOU COULD SHOW ME? I AM STILL SEEING THIS UNDER EXCLUSIONS FOR REG BCBS...Treatment of obesity or weight control or any complications arising out of or related to such treatment, whether or not you have other medical conditions related to or caused by treatment of obesity. HOPEFULLY YOU CAN DIRECT US ALL, I AM NOT SEEING IT ON THE WEBSITE, ALTHOUGH AM HAPPY FOR MORE CHOICES IN 2006!! AND YOU LOOK FABULOUS!!!

This is for 2006. Here is a link to the PEBB newsletter for August where it explains it. This is for the PPO plans, and Kaiser already covers it: http://pebb.das.state.or.us/DAS/PEBB/august05.shtml#Bariatric_Surgery_Benefit

THANKS A BUNCH! WOW! WHAT A VICTORY!!! HERE IS WHAT IT SAYS PEOPLE : Bariatric Surgery Benefit The Benefit Board has voted to include a benefit for coverage of bariatric surgery for morbid obesity in PPO plans for the 2006 plan year. In its RFP for medical services beginning in 2006, the Board asked proposers to respond to PEBB criteria for considering coverage of these surgeries. The Board's review of medical evidence on outcomes of such surgeries showed strong evidence for the following criteria: Patient body mass index of 35 or greater and a diagnosis of diabetes Patient participation in specific pre- and post-surgery intervention programs Provider requirements related to experience, outcomes, and pre- and post-surgery program support. Each of the apparently successful vendors for 2006 medical plans has criteria that vary from the Board's. The Board is working with the vendors to align criteria as closely as possible. More information on this coverage will be available during Open Enrollment

Hello...this is my first time posting and I'm just trying to get more information. I'm plan to take a job with the state, but I need to know if the new coverage for bariatric surgery for Oregon State employees includes the lap band procedure. Do you happen to know, or can you direct me to someone who might? Thanks!!

I'm not sure if it covers the lap band or not. You can follow the link in the earlier part of this thread and see if you can find out there. It might vary from plan to plan also... Dina

Hi Julie! We have BCBSO and they will NOT cover lap band, only RNY. Here is the exact copy I found on their website: ******* New for 2006: Bariatric surgery benefit for PEBB members Your PEBB health coverage includes a Bariatric Surgery benefit for the treatment of morbid obesity. Below, you'll find important information about qualifying for this surgery. Regence BlueCross BlueShield of Oregon only covers Roux-en-Y gastric bypass. To qualify for this benefit, you must meet the following criteria: Your Body Mass Index (BMI) must: Equal at least 35 with diabetes OR Equal 40 with another medical condition OR Equal 50 with or without another medical condition You must have already completed a six-month program, whi*****luded: * Dietary counseling and education * Medical evaluation * Psychological evaluation * Successful loss of at least 5% of your body weight over the six months The surgery must be performed in a Center of Excellence recognized by Regence. Call for pre-authorization: Surgical treatment using the Roux-en-Y gastric bypass requires pre-authorization. If you meet all three of the above criteria, please have your physician call Regence Customer Service at 1 (800) 452-7278 for pre-authorization. No other surgical procedures are covered by the Plan, including, but not limited to: Gastric banding Adjustable gastric banding Vertical banded gastroplasty, Mini-gastric bypass (gastric bypass using a Billroth II type of anastomosis) Distal gastric bypass (long-limb gastric bypass) Biliopancreatic bypass Biliopancreatic bypass with duodenal switch Need more information? If you have any questions about this benefit, call us at (503) 220-3849 or 1 (800) 826-9813.