Question:
I heard that some Blue Cross/Blueshield insurance companies are going to stop paying

for bariatric surgery in the near future. My friend is just starting to investigate having a RNY and has BC/BS Alliance choice in Missouri. CAn anyone shed some light on how well they approve surgery? Thank You. Carol Holmes    — Carol H. (posted on October 20, 2002)

October 20, 2002
This question comes up on a fairly regular basis. There are so many different companies under the banner of BCBS is is impossible to give a generic yes or no answer. The best thing you and your friend can do is to check directly with your insurance carrier. I have BCBS managed by Highmark out of Pennsylvania, they are not making any negative changes to their coverage for WLS. However the local BCBS provider (Regence) that my coverage is provided by has an iron clad exclusion for WLS. So you see, there can be huge differences. BCBS is not the monstrous company that some think it is, it's just a name attached to hundreds of plans. Insurance can be nerve wracking and I wish you and your friend the best in your journies. ~Peace
   — Joscelin

October 20, 2002
I have Empire BCBS of NY, and I had to switch Surgeons a couple of months ago. It seems that Florida BCBS did not choose to continue their contract with my original surgeon. He does WLS only, and the ladies in the insurance approval office told me BCBS will be excluding WLS from all new policies effective 01-03. I do agree with the previous post though, becuase BCBS is an administrative organization, and not one company nationwide. Your best bet is to try to pre-certify before the end of the year, just to be safe. Good luck,
   — Jennifer W.

October 22, 2002
It is going to depend upon your specific policy and your company (if through employment) as to what they will pay for and not. It also is going to depend upon state laws, as some state laws are starting to mandate coverage for WLS. I don't think there is any Blanket policy from BCBS just individual. My wife who had BC-BS of Michigan had no qualms whatsoever getting approved with BMI of 43 and only joint problems as co-morbidity. I had BC-BS of Indiana/Ohio and had BMI of 63 and 6 out of the 7 comorbidities that NIH says makes WLS medically necessary, and they fought me tooth and nail in getting approved. I finally hired a lawyer (Obesitylaw.com) and got approved. So it all depends upon which BCBS and what your specific policy is.
   — Dell H.