Question:
I know that Blue Cross is going to stop covering wls surgery

after 1/05 but my question is this... Is it going to be harder to get approval between now and then? My fiance has blue cross blue care and i am wondering if after we get married this month would it be worthwhile to get added to his insurance to try to get approval... Any luck out there???    — Sharee *. (posted on May 7, 2004)

May 7, 2004
In my opinion, it could not hurt to have secondary insurance available to you. I am sure that most will tell you that every BCBS policy is different so you may or may not meet any obstacles. I was just approved with BCBS recently and originally thought I would not be able to have the surgery this year based on all the hoopla surrounding BCBS changing their requirements. My surgeon sent the first letter requesting the surgery 01/05/04. I received a letter at the end of January saying I needed to show 12 months worth of supervised diet history and nutritional counseling. I was so stressed out about it and it was at that time I started a weight management program thru my surgeons office. I was originally told that I should undergo a supervised diet and nutritional counseling for 6 months and then resubmit to BCBS instead of waiting the full 12 months. I decided not to wait and submitted what I mid March and was approved the end of April. I did not think I had enough documentation to meet the requirements, but I was approved. I mention all of this because, I was told that my employer may have a rider in their policy that supports WLS 100%, but their are other companies out there that exclude it. I read your profile and see that you have been considering WLS since July 2003. I hope that you have started a supervised diet and if not please do so immediately. It may be harder than you think to get approved, and then again it may not be hard at all. No one can say for sure. Hope this helps, Lap RNY 06/03/04
   — ToriJ

May 7, 2004
Sharee, please post a link to the information regarding BX not covering WLS anymore. Having been in the insurance industry for over 5 years it really angers me when people make blanket statements like this. If BX as a whole is no longer covering WLS please provide documentation. I'm sure we would all like to see it so that we may slam numerous emails/letters/phone calls to them to rally support for all of us on this journey. Rebecca Perkins 10/03/01
   — RebeccaP

May 7, 2004
Hi Rebecca. The one that I know for sure has announced they are dropping coverage as of next year is BC/BS of Florida.
   — Jim F

May 7, 2004
Wonderful, Jim. Please show me this. I live in florida so that's even better. I would love to pester the hell out of them for this fact. BX is somewhat like a franchise...each segment can make their own rules. If BX of Florida is trying to do this, then I would like to get the email address, mailing address, and phone number for the CEO so that we all may contact him. I think he needs to hear from us. Rebecca
   — RebeccaP

May 8, 2004
http://www.bcbsfl.com//ocyh_our_company/currentDetails.cfm?ID=20040213163654&Method=Full&Cache=Off Is the link where BX of florida states it will be removing WLS as a benefit from SOME of thier products. Not all of them. The Chairman and CEO of BCBS of FL is Michael Cascone Jr and can be reached at PO Box 1798 Jacksonville FL 32231-0014. Mark S. Wright is the contact on the document itself and can be reached at 904-905-6935. I will be sending a letter to the CEO asking for an email address. Once I receive that information I will post it frequently here on these boards so that we may all just click a button to let them know how we feel. If you should feel the need to contact by snail mail....yea for you.
   — RebeccaP

May 8, 2004
Here's a recent CNN articale that mentions it: http://www.cnn.com/2004/HEALTH/03/03/gastric.bypass.ap/
   — mom2jtx3

May 8, 2004
Rebecca, I also have seen news articles indicating that BCBS of Florida will no longer cover WLS in any of their standard policies. Obviously each employer can choose to buy a custom policy and have it covered. I have also seen where numerous people are having problems with BCBS of Illinois not covering without a long supervised diet etc. That just started with 2004. I have not seen any of these two things being applied to any other BCBS policies throughout the country. Either they are keeping it very quiet or it's just two factions of BCBS that are going in this direction. I am 99.9% confident that the BCBS policy I have, which is developed by the State of WI for it's employees, will always cover WLS. It is the most expensive policy but has no limitations where you go etc. I do not know if their requirements have changed but I had no trouble getting approval. <p>If you are confident you meet the qualifications, and can find a surgeon who will get you in before the end of the year and are 100% sure they cover WLS then I would get added ASAP. You should be able to determine if it is a covered benefit by looking in your fiance's benefits booklet under the exclusions section. There will be a statement in there about treatment for weight loss. Usually it says nothing is covered unless you are morbidly obese and have associated disease etiology. If that exception is in there then the next thing is for you or your future hubby to call and find out what the qualifications are to be approved for WLS and what docs are covered. You have a bunch of legwork to do on your end but it just may work out.
   — zoedogcbr