Question:
Information about BC/BS
My husband has recently gotten a job.. Thank you Lord.. the insurance that we will have is BC/BS. I was just wondering if anyone could tell me what they have had to go through to get approved through them. Do they consider being morbidly obese and pre-exisiting condition? Thanks for your help.. — Tracie (posted on February 16, 2005)
February 15, 2005
Most plans will have a pre-existing condition clause in the contract
(although some very large companies have it removed). However, if the plan
does have a pre-existing condition clause, unless you have been seen or
treated by a doctor for that condition, then it is not pre-existing.
Treatment would include testing, prescription medications, etc. So if you
have went to see a WLS doctor in the past 6 months to discuss having RNY or
any other type of WLS, then the condition would be considered pre-existing
and you would have no coverage for that condition until you have been
insured for a specific amount of time (typically a year).
— Patty H.
February 15, 2005
I have BC/BS and I have to say that it was 1000 x's easier then I thought.
I was JUST over the line of where I needed to be and it took less then 24
hours to get approved. My docs office took care of everything. Best of luck
to you!!
— Splenderella
February 16, 2005
Pre-existing varies depending on the insurance. If you had a lapse of
coverage of 63 days, than all services would be considered pre-existing (at
least in my state). Anything less than 63 days is not pre-existing. Check
with your state's dept. of insurance on how much time could lapse between
policies for you to be considered pre-existing.
— Nicki F.
February 16, 2005
I have BCBS in NC and I didnt have any problems at all. It only took less
than 48 hours to get approved. As long as you meet the requirements which
justifys that you are morbidly obese it shouldnt be a problem to get
approved. Also make sure your employer has WLS in their policy that is the
most important factor through the process.
— Blest
February 16, 2005
I have BC/BS (Wellmark) in Iowa. Believe it or not, they approved my RNY
the day after they received the info from my surgeon's office!!!!
Unbelievable!!!!
— M C.
February 16, 2005
My surgery was approved almost immediately with NO hassles. I truely think
it was so easy because Bariatric treatment cener ( now Barix Clinics) Knew
their stuff on submitting, sent all necessary info right the first time. It
helps to work with some one who is experienced and has done this so many
times. I did not have to do anything but wait. BCBS approved with in days
of recieving the info.
— **willow**
February 16, 2005
This is impossible to answer because BCBS could be the insurer or an
administrator for a self-insured company. If it is a standard BCBS policy
with normal exclusions then you have a 50/50 chance of it being covered.
Some of their HMO's do not cover WLS but usually the PPO's and POS
contracts do. In my case, BCBS just administer's the policy for the State
of Wisconsin and the State decides what things they want in their policy.
I'd be willing to be that there isn't a standard BCBS policy that is
identical to ours. So until you see the policy book it is impossible to
know if it will even be covered. If it is a covered procedure then usually
approval isn't a big problem with BCBS. They may however, be enforcing the
6-month doctor supervised diet, which would delay you getting approval as
you would not want to start that until after your 6-month pre-existing
exclusion was gone, assuming you have one. Most likely you will be able to
get surgery if you meet the criteria but it may be delayed a while as you
have to jump through the hoops. Good Luck!
— zoedogcbr
February 17, 2005
I have BC/BS through a private plan (not through my employer) and I was
approved the same day they recieved my information. I didn't have any
co-morbidities, my BMI was over 40. On my plan you have to have a BMI of 40
or over or 35 with co-morbidities to be considered. Also, here in WI they
don't cover the Lap-Band procedure. They cover RNY and VBG. Not sure if it
will be the same in your area. Good Luck!!
— Jae117
February 18, 2005
I'm not sure what your policy states, you should be able to either look it
up online or call the company and request a book. My particular policy w/
BCBS of Illinois requires a BMI of 40 or more (or 35 w/ significant
co-morbidities) 2 co morbidities or more, 12 months medically supervised
diet history, 5 years documented morbid obesity, and a pysch evaluation.
Good luck to you, God Bless :)
— Lea H.
Click Here to Return