Question:
I'm reading on the message board about BCBS not covering this surgery any more

My surgery date is October 11,2002..I'm from NH.....HELP!!    — Anne B. (posted on August 24, 2002)

August 24, 2002
I too have heard that after 2002 BCBS would no longer pay for bypass surgery. From what I understand, too many people are requesting it and they want to re-evaluate. I don't know this for fact. I am in Florida.
   — Kay S.

August 24, 2002
Depends on what BCBS plan you have. Tennessee is no longer covering it. BCBS of Florida has notified the Department of Insurance that in 2003 they will no longer cover it. Now, it is an exclusion on policies, unless medically necessary. In 2003 - It will not be covered PERIOD!!! What a shame, I like THOUSANDS of other, feel this surgery save my life.
   — Sharon H.

August 24, 2002
I also would like to know the source of this information. BCBS is not a nationwide monolith, although the numerous local BCBSs are loosely affiliated (I think there were over 90 of them nationwide at one time, & I don't know the number now). In some markets, BCBS affiliates are actually competitors, or at least treat each other that way. I don't think there are very many nationwide policies on what surgery each BCBS will cover, if any. It's my impression that the BCBS's already vary widely in what they require and pay for with WLS. Then, there's the fact that not only are BCBS affiliates separate from each other, but a single affiliate -- for example, Trigon -- will write different policies with different employers, therefore setting forth different guidelines. Then you have the wrinkle of those few jurisdictions (three states & DC, I think) that require insurance to cover WLS under certain circumstances (for example, if the employer is large enough). There's certainly cause for concern about BCBS insurance with all these rumors, but I suspect that whoever heard or was told this information was dealing with a specific BCBS affiliate or two and may not have been hearing about a nationwide policy adopted by all the BCBS's. That's just a guess, though. Keep asking!
   — Suzy C.

August 24, 2002
I just got my Anthem BC/BS (PPO) renewal packet in the mail. I looked and sure enough, they STILL COVER WLS IF IT IS MEDICALLY NECESSARY!! Now, there are MANY MANY different BC/BS. Just in this area there is Anthem, High Mark, Keystone, and Mountain State! I think they all have slightly different rules and regulations.
   — Stacy C.

August 25, 2002
I have BCBS of TN. I spoke to a supervisor when I was working on my approval. She told me that as of January 2002, BCBS (not just of TN) had posted a memo saying WLS was no longer covered. UNLESS, the policy you have at the time of service does not have an exclusion and you meet the requirements. Further, when that policy comes up for renewal WLS would be dropped as the guidelines for BCBS have changed. All surgeries that have been approved is based on coverage at the time of service. Which she explained meant to me. My policy was already active in Jan. 2002, and I meet the requirements, but I have to have my surgery before renewal, because it would be dropped when the policy was renewed. I know there are tons of BCBS policies and I don't know if it applies to self paid insurance such as Wal-Mart, which we know doesn't cover this, but other companies who have the same type of self pay. Good Luck.
   — Pam G.

August 25, 2002
I have BC/BS of Texas and I was denied because WLS is an exclusion from our policy. However, I was able to get the surgery covered as an "exception".
   — Elizabeth S.

August 25, 2002
My employer did not get BC/BS until July 2002, so it can't be ALL of them! I was approved in one day! In fact, the letter I received says I am eligible to have surgery any time up until sometime in Janurary of 2003, and if I need to extend that, to let them know. I think it just depends on the policy you have and what your employer chooses to exclude. Good luck to you.
   — Terri Z.

August 28, 2002
each employer negotiates the policy that covers their own employees depending on how much they are willing to pay for premiums. there are VERY MANY differnet policies whether you are hmo, ppo, etc. some bcbs hmo, ppo policies cover & some dont. I had a marvelous experience, 9 day til approval, and when I called the person I spoke with was congradulating me and told me exactly what to make sure was submitted for fast approval, and he even shared with me that a guy in his office had a rny. and had lost tremendous amounts of weight! so do not take one persons experience and apply it to your situation, give it a chance, make sure you give your ins co all the info they need. By the way WLS is the ONLY weight loss program my BCBS policy covers, no other diet programs even if medically supervised and No diet drugs except for morbidly obese
   — **willow**