2012 06 20 11.23.33

Blue Cross Blue Shield of Florida – Good News?!?

Positive Changes to Bariatric Surgery Medical Policy

Effective August 1, 2012, BCBS of Florida has updated its medical policy number 02-40000-10 to actually (or at least theoretically) improve the chances that patients will get approved for surgery.  Before anyone goes throwing them a parade, please remember that this is still a company which seems to take a sadistic pride in making sure that bariatric surgery is excluded in their contracts.  So while these changes are good for patients, they only apply to those few patients who actually have coverage with this company!

The major positive change is that they eliminated two time barriers patients have long fought against to gain approval.  The first is how long the patient needs to be morbidly obese before qualifying for surgery – – the second, and perhaps most beneficial, is the elimination of a time period for non-surgical weight loss efforts.  The requirement now states members must have “made multiple attempts at a non-surgical management weight loss program….”

These are both among the most common reasons for denial we fight against.  Click here to read more about these common denial scenarios. →

BCBS FL also appears to explicitly add SLEEVE GASTRECTOMY to the list of covered procedures, explicitly included with “Roux-en Y gastric bypass (i.e. up to 150 cm), laparoscopic adjustable gastric banding, biliopancreatic bypass with duodenal switch, vertical banded gastroplasty, and sleeve gastrectomy…”  Also added is the BPD (Scopinaro procedure) when the member’s BMI is greater than 50.

Private Property of Blue Cross and Blue Shield of Florida. This medical policy (medical coverage guideline) is copyright 2012, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF.

So while this seems like it might be good news for patients, I always am concerned how this new policy will be interpreted.  For instance, if a member needs “multiple attempts” at non-surgical weight loss I envision some aggrieved patient being urged by someone at BCBS FL to have “just one more try…” before he/she will be approved.

Lastly, I cannot help but wonder why BCBS of Florida, as well as so many other insurers across the country, try so very hard to SCARE people away from sharing this information?!?  While I won’t blatantly violate their so-called copyright by posting the link or uploading a pdf (although I am sorely tempted to do both!), I will tell you that we are happy to discuss this change with any patients facing a possible denial or  providers caring for BCBS FL patients and invite you to CONTACT US →.  I’ll also tell you that you can access their medical policy by going to www.bcbsfl.com, clicking on the PROVIDER link, clicking on MEDICAL INFORMATION and (FINALLY!) clicking on MEDICAL POLICIES.

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