Question:
OK, FOR THE LAST TIME--is BC/BS stopping coverage for WLS surgery??
What is the story about BC/BS paying for WLS surgery? I have heard from multiple sources that they are not paying as of 1/1/03. Then I heard that yes, they are paying, but it depends on your policy. THEN I heard that no, as of 1/1/03, BC/BS will not pay under any circumstances. I called BC/BS myself and asked about the 1/1/03 cutoff date and they said "no, we haven't heard anything about that".....but I don't believe that for some reason. I have BC/BS of NJ, Traditional Plan C--it's NOT thru my employer; it's an individual policy that I hold independently. DOES ANYONE KNOW DEFINITELY? Thanks!! — Joyce C. (posted on November 7, 2002)
November 7, 2002
Did you call BC/BS yourself?
— Jennifer A.
November 7, 2002
All I can tell you is what BCBS told me. I have BCBS of IL and they told
me the same thing yours told you. The girl I spoke with said that if that
were happening, she would probably know by now and she felt certain it
wasn't. She told me there were several people at her job that were going
to have this surgery. She also told me that all BCBS' are different. They
are all independent of each other and there is no "blanket"
policy that applies to all BCBS. She said that just because one of them
decides to drop it (which I think Florida is) that has nothing to do with
any of the others. I, too, am a little concerned because I am awaiting
surgery and I'm not sure if I will have it before the end of the year. But
I decided I have to trust what they told me. I'm not sure why they would
lie. Hope this helps!
— Kathy S.
November 7, 2002
The answer is this definitely......NO, THEY ARE NOT CEASING COVERAGE FOR
WLS. Bariatric Surgery will still be covered after 1/1/2003. Now, that's
not to say that some specific policies offered by some employers or
individuals may stop covering it. But, before that makes anyone hysterical
please remember that BCBS (and other insurance companies as well) cease WLS
benefits AND implement WLS benefits EVERY SINGLE DAY OF THE YEAR depending
on the specific policy. Employers are continually changing insurance
coverage plans, dropping some things, picking up others. 1/1/03 is not a
red leter day for Blue Cross or any other insurance company. It's just the
beginning of the calendar year for our society. My BCBS policy, for
example, renews in November of each year. If my employer chose to offer a
different plan that didn't include WLS then the change would occur in
November. BCBS would not cease WLS coverage nationwide on the first day of
the year simply because that's not the way they operate. Each state has an
insurance board that governs how policies are administrated, then each
employer that offers benefits governs other specific areas of their
policies. BCBS is not governed on a National Level in respect to ceasing
coverage on WLS everywhere. It's reported that there are over 8000
different BCBS policies available in my state alone. You can relax - even
though it doesn't always seem like it - BCBS isn't the enemy (nope I don't
work for them). It's the employer/employee or private purchaser who
ultimately determines exactly what their policy will cover. Best wishes to
you.
— ronascott
November 7, 2002
I HAVE BC/BS HMO IN FLORIDA, I HAD TO HAVE MY SURGERY COMPLETED BEFORE THE
END OF THE YEAR. I WAS TOLD BY MY DOCTORS OFFICE THAT THEY WILL STOP DOING
THE SURGERY FOR BC/BS PATIENTS ON 9/20/02.THEY PUSHED MY DATE UP SO I WOULD
BE COVERED.
I HAD MY SURGERY ON 9/11/02. THEY COVERED EVERYTHING.
— ROBIN T.
November 7, 2002
I can not speak for all Blue Cross and Blue Shields, each states coverage
is different. They are all indepently owned. As for BCBS of Florida, they
will no longer WLS, unless your group buys a rider with the policy to cover
WLS. Depends on when you covered renews. If it renews before 04/01/03 WLS
should be covered for the year of 2003. If it renews 04/01/03 or after, it
will not be covered. If you have any questions, please email me.
— Sharon H.
November 7, 2002
okay, I understand that every BC/BS is different. BUT on my open
enrollment forms a couple of weeks ago, there was an announcement under
'coverage changes'. It said "BC.BS will be changing to a standardized
national plan" Now, that may mean a lot of things. But my policy
also listed, under limitations and exclusions, that WLS would be covered as
long as it was deemed medically necessary. Hope this helps....Ann
— Ann H.
November 7, 2002
My surgeon's patient liason works for BC/BS of Texas. She says they have
had no word of the surgey no longer being covered unless it is excluded on
the individual policy. That means that when companies select the policies
for their employees, they can exclude anything they wish. If there is an
exclusion, it is put there by the people buying the policy. However, since
you have an individual policy, I don't see that that would affect you. I
do know that Bc/BS HMO (in Texas) does not cover the surgery but the PPO
does unless it is a written exclusion.
Like the previous poster said, Blue Cross varies in every state and even
from policy to policy. The best thing you can do is consult the insurance
company.
— Patty_Butler
November 8, 2002
I spoke with the Medical Director, along with the Medical Supervisor with
BC/BS. Both informed me that it depends on the plan your employee has for
you. Mine for example is Traditional BC/BS of MI(even though I live in NC)
and we have it through General Motors. In my case, there will be no change
on wls unless they bring it up for review at contract negotiations in three
years. It's completely up to the employer's plan.
— meltedbuttr
November 10, 2002
I had surgery 09/03/2002 and was insured by BC/BS of Texas. They paid it
all except for about $2,000.
— Debbie C.
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