BCBS Plans in IL, TX, OK and NM Now Cover the Sleeve !!!

 Wow this must  be fresh off the press because I called BCBSTX on Tuesday and it was still investigational.  Can't wait to doc's office opens so I can confirm with them!!!  Thanks for the update!!! JJ

I'm crossing my fingers for you JJ! This is definitely fresh off the presses, probably more like prepress. The patient coordinator from my surgeon forwarded an email to me that she received early Thursday morning.

My eyes are feeling with tears after reading your post. Thank you for sharing. Please continue with any additional info. I've been fighting with BC/BS of Okla. for over 6 months and refused to give up, figured we would end up in court. Please friend me if you would. Thanks again.

God Bless

Steve

 

Hey

 

Hope this is true. I started my appeal process 2 weeks ago with BCBSIL. I check their policy web site everyday to see if it changed. It is still showing a 9/2009 date and “investigational" I even called and they were no help at all.

I know it is just a matter of time and I’m hopping it’s a matter of a short time.

 

Lou

 

PLEASE let BC/BS of North Carolina follow the trend!!!

 I got the call on Friday!!!  Whoo hoo!!! I'm so excited!  ~ JJ

I don't get it!

I have BCBSIL - i went again to their web site and it still has "no" dated 9/2009. I went on the BCBSTX web site and it has the same procedure - and it also is @ 9/09.

What did your email say? I'm waiting for an answer from by appeal...

Lou

Ok – different story ….   I just called BCBSIL and found out my appeal  was approved for sleeve gastrecomy 43775… It took them less then a week – it was approved on the 10^th – did not find out until I just called.   “Reason: Approval is based upon recommendation by an external peer reviewer, after consideration of the member’s individual clinical cir****tances"   Now I’m doing the happy dance …   Lou

I am a bcbs of texas member and I was shocked when I got back from vacation and read the clinical policy bulletin again.  I was all set to finish my requirements, submit to insurance, have it denied, then appeal, and hope to MAYBE get the surgery late in the year.  

This is good news, now the reality of having surgery has set in and it is making me a little nervous!  

Here it is!
 

• "Open or laparoscopic sleeve gastrectomy may be considered medically necessary (when specifically included as a benefit or covered service in the member’s benefit plan, summary plan description or contract) as a surgical treatment option for patients with morbid obesity who meet the eligibility criteria for surgery, including lack of response to the required conservative measures listed above."