Question:
Blue Cross Blue Shield (Blue Choice)?
Do they cover gastric bypass surgery? Any one know? — outofpatience68 (posted on March 24, 2006)
March 24, 2006
I have BCBS-TRS (Texas Retirement System) and they covered mine. In fact
they covered the hospital and labs 100%. Mine was done last June. Good
luck.
Laural
HW-313
SW-292
CW-192
GW-135
— Laural D.
March 24, 2006
I had Empire Blue Cross-Blue Shield and they covered EVERYTHING except my
$250.00 hospital co-pay. I now have Anthem Blue Cross-Blue Shield out of
Richmond, VA, and they cover all my post-op medical needs.
— SharDurc
March 24, 2006
I had BCBS-PPO in Detroit, Michigan. They covered all except my co-pays.
I did have Blue Care Network (the HMO for BCBS) and the denied me. I then
changed to BCBS-PPO at open enrollment time, and had no problem.
— Danita S.
March 25, 2006
My Blue Choice Option (NYS) did.
— Danmark
March 25, 2006
I will have BC/BS soon (as soon as I'm a full-time college student) and
they cover everything 100%; however, some plans don't. The only way to know
for sure is to call the 1-800 number on the back of your card and ask a
BC/BS representative. Good luck.
— kjoy
March 25, 2006
I am a Blue Cross authorization nurse. according to the Blue Cross
guidelines bariatric surgey is a covered benefit if you meet the criteria
set forth in the guidelines. There is a list. You must be be at least,
between the ages of 17-62, some medical plans will do different ranges,
have major morbid obesity: BMI over 40 or 35 with 2 comorbidities: heart
disease, highblood pressure, GERD, Diabetes, hyperlipidemia, (there is
another one)..,you have to have been on a medically supervised 6 mos wt
loss diet.They cover certain hospitals and certain MD's depending ;on the
medical group and the hospital has to be their center of excellence for
bariatric surgery or you will get a portion of the bill( esp if you are an
HMO. If you are a PPO it is easier. It is best to call your rep for Blue
Cross and get the scoop, ask for a listing of their approved baratric
surgeons and start interviewing them, then they will get you started,
because they are already contracted with the insurance group it will be
much easier, when they are noncontracted it gets much more difficult and
expensive. Hope this helps..By the way I got to approve 2 bariatric
surgeries this last week, I was so excited for them. I can't wait for
mine. Hope this was helpful. DJ
— DeJay
March 26, 2006
I have BlueChoice, Missourii and they approved my surgery quickly. Just
have your prospective surgeon's ofice staff submit EVERYTHING at once.
(Document in writing previous diets - weight lost/regained, have a psych.
evaluation - BLueChoice provided a name for me here -- and have a letter
from your primary care doctor that says you have some comorbid. problems -
even if they are just snoring or heartburn) This really helps speed up the
process. Good luck! Rebecca
— Beckii
March 26, 2006
Blue Choice Option in NYS pays for WLS. But you are in another state. Call
your local Dept of Social Services and ask.
I'm assuming YOUR Blue Choice is also part of Medicaid???
— Danmark
July 5, 2006
Blue Cross and Blue Shield both have guidelines that state Gastric bypass
and lap band , duodenal switch are covered for morbid obesity for BMI over
40 or BMI >35 w/ comorbidity : Heart disease, Osteoporosis, Diabetes,
HTN . These are national guidelines. However the way these guidelines are
administered and interpreted are left to each region, which is why there is
such a discrepancy for each member; add to that mix each individual
employee group and it mayget more difficult to get approval. It all comes
down to knowing what the actual Healthplan guideline states, the phone
reps don't have access to it. You can get a general idea of what all
healthplans gauge their decisions on for procedures by accessing the
website : CIGNAMEDICARE guidelines .com, most insurances base their
criteria on medicare, because it is the government standard of practice. I
hope this helps. FYI, Some of these insurance groups also run the approval
process through a computer program like Mckesson criteria, that requires
the insurance co. to run the member through a prescreening: EGD w/
h-pylori testing. Labs: TSH, CHEM 24, CBC, PT/PTT, CBC, Lipid panel,
PFT,cardiac clearance,psych clearance, nutritional counseling, (if kidney
disease..renal clearance),Primary care physician referral w/ history of
failed dietary attempts, and general health profile PE. , before allowing a
baratric consult , So if you find an baratric MD who puts all the pieces
together for you , it makes this whole process a lot simpler. Hope this
helps. DJ
— DeJay
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