Cap Blue Cross PPO...Pennsylvania - ThinnerTimes

Jenny3 · 01-29-2006, 08:31 AM

I am new to this forum and seriously considering GBS. I have an appointment with my PCP this coming week. I am almost afraid to get my hopes up that insurance would cover this for me. My BMI is 41.6 and I am 100 lbs overweight by the height/weight charts. I also have been dx'd with PCOS. Do you think this sounds like I will qualify? Does anyone know anything about Capital blue cross PPO requirements for coverage?

Thanks for any help.
Jen

AThinnerSandyFor2006 · 01-29-2006, 02:47 PM

I have NJ Horizon Blue Cross Blue Shield PPO. I was told as long as it is medically necessary the surgery is covered.

brookscn · 01-30-2006, 11:18 AM

Jenny:
I'm in California, but my corporate headquarters is in Pennsylvania, and my insurance is Capital Blue Cross PPO. According to my medical program, the insurance is covered if I fit the criteria for MO (BMI over 40 or BMI over 35 with co-morbidities). But, that medical program is determined by my company ALONG with CapBlueCross. So, you need to look through your medical plan completely (read it carefully, you'll probably find information under the "exclusions" section). Know what your company has agreed to with CapBlueCross.

My paperwork is all done, and is currently being submitted to insurance. I've got my fingers crossed (and toes, and eyes and whatever else I can cross)

AThinnerSandyFor2006 · 01-30-2006, 02:22 PM

I have NJ Horizon Blue Cross PPO and the criteria is the same as Brookscn. I've contacted my HR Rep who said as long as it is medically necessary and I fit the criteria I should have no problem

Jenny3 · 01-30-2006, 07:06 PM

Thanks for our replies. I called today and they didn't get into exact requirements...just said that the doc recomending the procedure would have to call and plead my case, then a bunch of MD's and nurses will decide whether or not to approve it. That doesn't sound too bad...crossing my fingers!
Jen