Question:
Has anyone heard that bcbs is no longer paying for wls?

   — Shelby G. (posted on February 3, 2002)

February 2, 2002
I have BCBS (Anthem, I don't know if that makes a difference- I don't know too much about insurance)...They paid for my surgery and hospital stay January 8th. I don't know if that helps, but at least you know they paid for one lately.
   — Angela B.

February 3, 2002
Insurance policies and laws differ from state to state. And employers can ask for exceptions to the basic policy. The only way to know what your insurance covers is to get a copy of the policy from your employer and read it to see what they will and won't cover.
   — garw

February 3, 2002
I have BC/BS Florida State Employees insurance and was just approved for Gastric Bypass on Feb. 1. 2002. So there is hope! Just keep after them. Good Luck!
   — Tammy M.

February 3, 2002
Just had surgery on January 30, 2002 that was approved by HighMark BCBS. No problem with approval.
   — [Anonymous]

February 3, 2002
Hi! I have Classic Comprehensive Major Medical (it's an individual plan I'm not employed) and I got approvel after my first leter on 1/27. My surgery is in one week..yay! :) I heard this rumor though too back in Dec. and I just called them and asked about it. I would also suggest you do that :) Take Care and Good luck!
   — blank first name B.

February 4, 2002
Hello! Yes! Blue Cross is denying everyone for this surgery. (in MISSISSIPPI) We own a small biz and have insurance through Blue Cross of Ms.I was turned down twice. anyway- I even asked our local carrier (good friend) if we could upgrade (pay higher company premiums) whatever, in order for them to cover this surgery. He said "nope..they will not cover it even if you are dying from heart failure due to being fat". He also stated that QUOTE: " Our company pays for anorexics hospitalzation , I don't see why this is any different". An eating disorder is an eating disorder--no matter how you look at it!
   — alison D.

February 4, 2002
It all depends on which Blue Cross/Blue Shield, what state you live in and the policy your company offers. My Wife has BlueCross of Michigan through her work and was approved without any questions in 3 days. Her BMI was 45 and very few co-morbidities. I have Anthem BlueCross/Blue Shield, through my work (out of Ohio/Indiana, we live in Michigan) and it was a pain all the way. They denied me the on original approval and 1st appeal saying that it wasn't medically necessary. Our policy states that it does cover WLS if it is considered as medically necessary. They claimed it wasn't medically necessary even though I have BMI of 62 plus 6 out of the 7 co-morbidities that qualify you for surgery. I hired Walter Lindstrom for the 2nd appeal and had approval in 3 days after he faxed them a 28 page appeal letter. It all depends on the insurance company. I know that Anthem BC/BS is famous for denying you until you put up a good fight. If you are having problems with insurance, I highly recommend Walter Lindstrom (wedsite obesitylaw.com).
   — Dell H.

August 24, 2003
Generally it depends on your employer as to what benefits they will cover. I had HMO-Blue Texas which is a subsidy of BCBS. My employer had chosen not to cover the benefit not BCBS. Now my employer has chosen to cover the surgery, and with a different insurer. Alot of times if you just get with human resources and talk to them they can and usually will give you information on this type of stuff.
   — toscamaddox

March 31, 2005
As previously posted it depends on your employer and the contract with BCBS. Medical policy posted on the Anthem http://www.anthem.com website lists the criteria to qualify for the surgery. Your best bet is to go thru your employer and request an appeal due to special circumstances if necessary. Always check your benefits before any major (and some minor) procedure(s) to be sure you are covered for that procedure or service. Your doctor can also verify benefits but you as the member are ultimately responsible to know your coverage limits.
   — LadyZe

April 1, 2005
I too have BCBS throught my husbands employer. I don't have coverage and I send a letter (along with my pcp) of medical necessity and requesting coverage. They responded with a solid NO Evidently, if they make exception for one, they have to for all and this would violate some insurance ordinance !
   — KV42505

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