Question:
Question for people with Blue Cross Blue Shield

Has anyone who has BC/BS had WLS even though there was an exclusion in their policy? I'm going to work at a place that has BC/BS and I don't know if they have an exclusion or not. The only reason I'm going to work there is for the insurance so I can have WLS..... and I'm just wondering what my chances are of this actually working out.    — Alisa Sheets (posted on May 5, 2004)

May 5, 2004
Blue Cross/Blue Sheild, just like all other insurances have MANY policies. The company you work for buys the one they want. That could or couldn't have an wls exclusion. You would have to get the actual policy booklet from YOUR company or another employee to check if there is an exclusion to find your answer.
   — ZZ S.

May 5, 2004
We have Blue Shield of California. My Group is Sutter. I had no problems in my process to WLS. My surgery date is next Monday May, 10 2004 at Sutter Roseville, Roseville CA w/Dr Walderp. They want to know the usaual i.e. diet history, Comorbidities (sp?) I started the process in Feb.
   — [Deactivated Member]

May 5, 2004
We have Blue Shield of California. My Group is Sutter. I had no problems in my process to WLS. My surgery date is next Monday May, 10 2004 at Sutter Roseville, Roseville CA w/Dr Walderp. They want to know the usaual i.e. diet history, Comorbidities (sp?) I started the process in Feb.
   — [Deactivated Member]

May 5, 2004
I have BC/BS HMO POS, you will have to find out what plan and policy you have. But I do believe BC/BS requires Referral from PCP, Medical Clearance, Thyroid Panel,Detailed Failed Diet History(what diet,the year diet tried,how much weight lost,how much gained back) Psychological Evaluation, Nutritional Evaluation, ,, BC/BS of Ga. is canceling gastric by-pass surgery in Jan.2005. So if you want it you have to get started now if you live in Ga. I am still waiting on approval from the Ins.
   — Terri M.

May 5, 2004
I have BC/BC PPO of Rochester NY. I had no problems. I had to have all of the testing done and a pysch evaluation and all that jazz but was approved within two weeks. Good Luck!!!!
   — Robin B.

May 6, 2004
i HAVE bc/BS OF WESTERN PA (PPO), AND i JUST JUST FOUND OUT TODAY THAT THEY WILL ONLY COVER ONE DOCTORS VISIT PRIOR TO WLS. OTHER THAN THAT, THEY SHOULD COVER EVERYTHING ELSE. THEY HAVE BEEN EXCELLENT IN THE PAST AS FAR AS COVERAGE.
   — jennifer S.

May 7, 2004
It really varies depending on the policy your company bought. I have BCBS of Oklahoma which would not pay for anything obesity related. But I also had BCBS of California which paid only for open RNY and not laparoscopic or lap band surgery at all (said was investigational). You will need to check your individual policy. If it is excluded I would say your chances of overturning that are slim to none. Good luck!
   — Michele P.