A question about BCBS approval.

[lsu2868 708]

I have a quick question for those of you who have Blue Cross Blue Shield. My sister and brother-in-law are both seriously considering being sleeved. She called their insurance today, BCBS and was told that they don't cover weight loss surgery. My thought is what if their Dr. prescribed or recommended the surgery? Has anyone else who has BCBS encountered this issue and if so, what steps were taken to finally get approved? Thanks in advance for the help.

[Bufflehead 6,358]

Whether BCBS covers the surgery depends on whether their employer chose to include weight loss surgery in their plan. If their employer excluded it from coverage, really the only way to get BCBS to cover it is to convince their employer to change their coverage plan when they underwrite for the next year. Your sister and brother-in-law should get their plan documents (they should have a member benefit handbook) and see specifically what it says about weight loss surgery or elective surgery. Usually if it is excluded, the handbook will say so. If it is included, the handbook should spell out the requirements for getting the surgery. The handbook varies for each employer so they need to make sure they have their own specific handbook.

[Tiny One 223]

I have Independence Blue Cross & was approved with no problem because my employer approved it in the policy. So it actually depends on how the policy is written. Did their employer exclude WLS from your policy completely? If so, then their Blue Cross plan will not cover it. It totally depends on how the policy is written. If its a self funded policy, they can go directly to their employer to request approval.

[Jerzygurl 372]

Yep. It is all in how the employer's plan is written. If it's not there, then there's no chance at all, it will ever get approved. The only other option is self-pay. My doctor as do many others, offer financing for surgery.....they can check into that possibility.

[skibunn42004 7]

I have BCBS and I got approved no problem. I have great insurance. My employer sees the benefit of fit employees and really trys to help.

[Jerzygurl 372]

I have BCBS and I got approved no problem. I have great insurance. My employer sees the benefit of fit employees and really trys to help.

We are blessed. My employer is the same. I feel bad for others that don't have the same.