Question:
Is it true that BCBS will stop covering WLS after 1/1/02?
I heard this from someone who claims that her friend works for them. She says that Blue Cross Blue Shield will no longer cover weight loss surgery after 1/1/02. I find this really hard to believe.I called my provider which is Highmark BCBS Preferred Blue PPO and the lady said that it wasn't true.I think everyone who has BCBS should call to make sure. — [Anonymous] (posted on December 9, 2001)
December 9, 2001
Hi Everyone, This rumor has been making the rounds on this board for
awhile. I contacted BTC in Ypsilanti because I am scheduled for surgery on
January 7th, 2002 and I wanted to make sure that it wasn't going to be
cancelled. The person I spoke with there said that they had not heard
anything like that from BCBS and that they have a large percentage of
people who have BCBS.
Please when posting make sure that you verify the rumor before passing it
on. This is already a nerve wracking process and to inadvertantly spread a
rumor that isn't true just adds to everyone's stress levels. I am sure
that there may be BCBS groups that are not going to cover the surgery as of
January but there are literally hundreds of different BCBS plans throughout
the nation. It is easy enough to verify if your plan is going to be one. I
don't mean to sound snotty or anything its just that this surgery is my
last hope and to hear things like this after finally getting approved just
adds to the anxiety. I hope everyone is having a nice weekend and good
luck in your WLS journeys!!
— Elizabeth P.
December 9, 2001
elizabeth u r absolutely right. we have already stressed over our ins co
approval or disapproval methods so why stress over a rumor. call ur
particular bc insurer URSELF & present this question to them. they r
the only ones that can give u the right answer. u might also want to
request a benefits book for 2002. see what the book says then u have it in
black & white. by the way...my 2002 book has the same exact wls benefit
as it did in 2001. as long as u meet the criteria ur wls will be approved.
u also might question the reason(s) ur bc is discontinuing this benefit. it
is not cosmetic surgery & morbid obesity is now recognized as a disease
by the NHI. insurance should cover the treatment (wls) as a cure or
possible cure for the disease, & consider it an elective but medical
necessity. (i hate the word elective). u have the right to appeal any
decision ur insurance co makes pertaining to ur health. most if not all wls
surgeons have dealt with this before & should be able to handle ur
particular case with ease.
— sheryl titone
December 9, 2001
i heard the same thing in a support group and unlike the other person who
posted an answer and does not want to be bothered with questions that upset
her, i am here to SUPPORT you. i too have BCBS and i am still not done with
the required testing needed before you can submit for approval. SO I
FREAKED when i heard this. i heard this yesterday (12/8/01), and the
person i heard this from was denied and apparently was told this from and
employee on BCBS who works in the appeals process of her claim. i asked
the same question myself on this message board Sat. i plan on calling not
only my BCBS but the insurance dept of my surgeon. they work with these
ins. companies EVERYDAY and i'll bet they can help us get to the bottom of
this.
— Tica G.
December 9, 2001
To the poster Elizabeth, this is eveyone's last hope not just yours. I am
70 BMI, I know about stress.
— blank first name B.
December 9, 2001
Hi Everyone, I did not mean to come across as rude. I consider myself a
supportive person. I am happy to answer or discuss topics with anyone.
What I meant was that there always seems to be someone who wants to start a
rumor that provides grief to someone who is already struggling through the
roadblocks to WLS. Usually the person starts the rumor "well my
friend's uncle's sister's boss heard that....." I was not critizing
the person who asked the question. I am sorry if I offended anyone.
— Elizabeth P.
December 9, 2001
ELIZABETH. This question was reasonable. Tica Gomez (listed below) is a
patient of my surgeon and she heard this information at the support meeting
yesterday. She heard it from people that attended the 2 meetings prior to
yesterday, and they heard it from our surgeon himself. He has 2 patients
that work for insurance companies (BCBS and Aetna) and they told him that
MANY if not ALL insurers in Florida or the Tampa Bay area would not be
approving WLS. The exception? Companies that specifically want to allow
WLS (where as before they would exclude it; now they have to include it).
This may not only be Florida. Insurance issues are dealt with on a state
by state basis. So, your state, or the state you're having your surgery
in, may not be affected. The poster probably posted in the hopes that
someone may have some more information for them...not just to be bashed
because you're not comfortable with certain questions. If you do not have
a constructive answer to a question then don't answer it.
— Kristin R.
December 9, 2001
Now I feel like a moron. As soon as I refreshed my page to see if my post
came through, I noticed Elizabeth posted a 2nd time. Sorry Elizabeth!
That was nice of you to come back and straighten things up. :0)
— Kristin R.
December 10, 2001
I contacted BC/BS of Fl. Health Options today and specifically asked about
WLS being excluded and the lady on the phone said no. She asked everyone in
her office and said that usually if a procedure is excluded they will
recieve an e-mail so that they can handle any questions that members might
have. The lady said she too was thinking of seeking approval for WLS in a
few months. I hope this is just some misinformation on someones part, but I
am personally glad that they brought it up so I could check it put myself.
It is too bad to see that people get so upset about rumors. Insurance
approval is hard for everyone.
— Tara J.
September 9, 2002
I spoke with a lady at blue cross and blue shield of tennessee and they ARE
NOT covering it... here is what the exclusion in the policy is...and it
isnt just my husbands employer...I was told that it is a statewide
policy...NOT COVERED ARE SERVICES OR SUPPLIES RELATED TO OBESITY, INCLUDING
SURGICAL OR OTHER TREATMENT OF MORBID OBESITY.
This is NOT a rumor...I got it straight from BCBS of Tennessee.
— iamtina
September 9, 2002
I have BCBS of Ky. And it is no longer covered.
— Oldsoul
September 10, 2002
I think what's happening is that BC/BS is different in different states,
and also varies by plan (PPO, Choice, etc.). And of course, it also depends
on the employer's preferences in their insurance contracts. I think
keeping this in mind helps when we deal with questions of insurance
coverage.
— [Deactivated Member]
September 10, 2002
You have to take in consideration that all bcbs policies are not the same.
When you call your member services office they only give you the info
pertaining to your policy that either you or your employer selected. For
instance, both my mother and myself have bcbs of Massachusetts ppo but her
employer opted to exclude WLS amongst other things so she cannot get the
procedure paid for through her employer. My employer on the other hand did
not exclude the procedure so My insurance will cover. Although it is the
same bcbs the company policy and inclusions are totally diferent. I hope
that made sense. Another thing to consider is the fact that not all
insurances change coverage in January. Again my insurance year is up in
April of each year. I hope that this helps everyone.
— Teekay80
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