Question:
BCBS making national changes to cover wls. Someone posted BCBS would be making

changes nationwide in 2003 so that all their ins. companies would be required to cover wls if medically necessary. If this is so, could someone please email me further info. or where I might get the info. I tried the BCBS website, but NOTHING> There are several people I know with BCBS of MS that would love & need to have surgery, but BCBS has an exclusion that you can't get around. I had to pick up a 2nd full time job to get ins. to cover mine & not everyone can do this. Please email me any info you may have. Thanks!!!    — Belinda W. (posted on October 25, 2002)

October 24, 2002
I don't know if this is true or not but my company just signed up with BCBS of Florida and there is a NEW exclusion they just started, they will not be covering the surgery according to my new book. They will also not be covering any complications arising from previous weight loss surgeries. This is an adendum to the origional book. They used to cover both. Not anymore. Very disappointing, really. My former insurance didn't cover anything for my surgery and I was looking forward to having one that would. When will these companies learn that this is a life saving procedure? What is wrong with these people, anyway?
   — KelBurt

October 24, 2002
I'm not about the answer to the orginal question. I have comment about Kelli's response. The kicker to all this Kelli is it could be that your company had chosen not to cover it. Each company selects the type of coverage they want to offer through an insurance policy. If your company wanted WLS covered it would be a part of your policy.
   — Cheryl S.

October 24, 2002
I have the great news!! It was me that posted about the "standardized national plan"!! My company has BC/BS of California, and we are doing open enrollment right now. When we got the new policy and limitations booklet, I jumped ahead to the obesity clause. This is how it reads..."Obesity Exclusion and Limitations: Services primarily for weight reductions or the treatment of obesity. This exclusion does not apply to surgical treatment of morbid obesity as determined by us if we authorize the treatment in advance as medically necessary and appropriate." Now, that in layman's terms, means that they WILL pay for it as long as you jump through all the hoops to deem yourself in medical need!! YEAH!! At the very beginning of the booklet it has the statement about the "standardized national plan" under the heading "Changes effective January 1, 2003." Hope this helps you out!! :*)
   — Ann H.

October 25, 2002
There is no "national" BC/BS. From their web site (http://www.bcbs.com): "We are the Blue Cross and Blue Shield Association, the trade association for the independent, locally operated Blue Cross and Blue Shield Plans."..."The 43 local member companies of the Blue Cross and Blue Shield Association have provided millions of families like yours with top-quality, affordable health insurance for more than 70 years." <p> As the web site says, the 43 local BC/BS plans are independent and locally operated. That means that there is *no* national standardized plan. Each individual BC/BS makes their own decisions regarding coverage of WLS (or any other procedure) and even that isn't the definitive word. If an employer has BC/BS, but if it's self-funded (the employer pays out the claims - all BC/BS does is the administrative work), the employer can exclude any procedures that they want to.
   — John Rushton

October 25, 2002
John is right.
   — RebeccaP

October 25, 2002
I had Lap RNY in June of this year and mine was covered through BCBS of Minnesota. They were wonderful, approval within 5 days, no hassles what so ever. I bet the exclusion is through your employer and that is something you will need to take up with them, it is hard to get them to change an exclusion but not impossible. Good Luck!
   — Cassy H.

October 26, 2002
As someone else stated, There is no national BCBS coverage...they are all independent of each other. BCBS of Florida will no longer cover the surgery as of 2003. As groups renew the WLS will no longer be covered. My group renews in January and the coverage for WLS ends in April, because my group would have already renewed, it will be covered until the next renew, January 2004. More and More Insurance companies are excluding coverage for this surgery. I feel it is a VERY BAD decision on their parts !! I like so many others, feel that, NO, KNOW THAT THIS SURGERY SAVED MY LIFE.
   — Sharon H.