Question:
has anyone been approved with there BC/BS policy read like this?

I have BC/BS plan code 340/840 with a written exclusion that reads "treatment of obesity, regardless of the patient's history or diagnosis, including but not limited to the following: weight reduction or dietary control programs, prescription or non prescription drugs or meds such as vitamins, minerals, appetite suppressants, or nutrional supplements, and any complications resulting from weight loss treatments or procedures." Has anyone had their policy read like this and been approved? -Monette    — Monette L. (posted on May 7, 2002)

May 7, 2002
yes mine read the same way but look at the wording it says obesity were morbid obese and there is a difference ask them about morbid obesity i will be having my surgery on may 14th and i have bc/bs care first ppo and they did not stall at all it`s in my profile good luck
   — rochele1970

May 7, 2002
My policy reads the same exact wording and my surgery is scheduled for May 15th..woo hoo! I have BC/BS of FL Health Options (HMO) and I was originally denied for not having 12 months of medically supervised weight loss history. After sending in an appeal with my medical records for the last 3 years, I was approved. The criteria that BC/BS explained to me in order to qualify were: 1. Being morbidly obese with a BMI greater than 40 2. Minimum of 12 months of documented medically supervised weight loss attempts 3. Psychiatric evaluation Hope this helps. Good luck on your journey!
   — Rachelle P

May 7, 2002
That part is just talking about diets and things like that. Look under Surigical Procedures. It would be listed there.
   — Lisa N M.

May 7, 2002
I have BC/BS HMO in New Mexico. My exclusion read like yours except it said "morbid obesity". No loop holes. If it doesn't say "morbid obesity", I think you have a shot. Best of Luck. By the way, I private paid, best 12,000 I ever spent. I am almost 8 months post-op and down 90 lbs. Margie
   — Margie W.

July 10, 2002
I have BC/BS Blue Choice and just learned that "weight loss" is not covered by my policy. However, they approved my lap roux-n-y a month ago and I had my surgery June 6, 2002. This all came about because they were not paying for post-surgical follow-up saying it was weight loss. Go figure. They finally told me that I needed my primary care doc to make the referral for the post surgical treatment to be covered.
   — Thomas M.

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