Does anyone know about BC/BS OK?

[DianaG 0]

Hi Misty,

They can't disqualify you for asking a question. Your group agreement with BC/BS will identify the benefits available to you. You need to get the booklet specifying these benefits. If the short version, you read, said that bariatric surgery was covered, then the policy booklet will give you more info on what is and is not covered. I really don't think you will be disqualified if you have the co-morbidities that the insurance company requires.

More and more insurance companies are finding that it is in their financial interest to fund this type of surgery. After all, you will be healthier and therefore they will not have to spend as much money on your healthcare in the future.

Sorta like when, years ago, I had problems with some birth control products and my only choice left was to have my tubes tied. The ins. co. said that they did not cover that. So I told them that since it was the only option I had left, that I guessed I would have to take my chances and if I became pregnant again, they would have to cover the healthcare cost of my child until he/she reached age 18. And who knew how many more children I might have in the future!!!Guess what, they decided to pay!!

So, hang in there and don't give up!!!I am sure it will all be fine!

[fabulous@fifty 1]

I have BC/BS of IL, PPO and was approved on the first attempt. As long as you meet all of the requirements you shouldn't a problem

[HappyMom 1]

I have Anthem BC/BS of California and was just approved yesterday. I have a BMI of 39, but with high blood pressure and type II diabetes.

The only requirements for me are a psych and dietician visit. I do not have to complete a 6 month diet monitoring, or any other monitoring/requirements.

BC/BS will pay 100% after I have meet my yearly out-of-pocket deductible.

I wish you good luck with your journey!

[brew44 0]

Okay everyone! Here is what my policy states from the 'exclusions and limitations' section for bariatric surgery.

Surgical procedures, services or charges related to weight reduction. Bariatric surgery is excluded except when ordered by the Primary Care Physician and in accordance with Medical Necessity requirements.

So now I guess I just need to find out what the medical necessity requirements are and to find a doctor who agrees with me that I need the surgery. My BMI is 43 and I have no co-morbidities. Also, I need to find out if it will cover lapband and not just rny.

So everyone; keep your fingers crossed and say a prayer!

Misty

[chrisdirects 0]

Hi, all,

I have CareFirst BCBS- they do pay for the surgery, but put you through the 6 month nutritional program first. I did that through my surgeon's office. He requires a whole slew of preoperative testing (seems like I've met every specialist in my area, lol!)- the insurance has paid for everything except 2 or 3 $10 office visit copays. I'm now waiting for them to issue my final OK so we can book the surgery. My surgeon has a backlog (too many cancellations because of the bad weather here), so I'm expecting to have it done in mid-March.

Every BCBS policy differs in their requirements, so it's worth a check...you might also want to consult with the HR folks where you work to help you.

Best wishes on your journey!

[brew44 0]

Hi,

Here is my update:

So far I have talked to a Lapband surgeons' office and because I have BlueLincs BC/BS of OK I don't need a referral to see them! I have an appointment set up for the 24th of this month to see if I qualify. If so, I can get started with my 6 month diet and nutritionist appointments.

Excited and hopeful!