Blithe5678

I ran into an issue today with my Highmark Flex Blue PPO 1000 insurance. The first rep I spoke to in Feb, said that I would have to cover 20% of the sleeve surgery, but today the rep said I wasn't covered at all for anything and there were no notes about the previous rep I spoke to. Because of my income I can get on Medicaid in Pennsylvania. I have been paying for insurance out of pocket, because I like my family doctor and I didn't want to have to go to a clinic. However, the surgeon's office said that it will be covered 80% and there maybe other things like the hospital that won't be covered. Has anyone in PA used medicaid for a sleeve? Does anyone think that I should spend more to get a new policy from Highmark which does cover surgery? Any other suggestions/help? Thank you!

I ran into an issue today with my Highmark Flex Blue PPO 1000 insurance. The first rep I spoke to in Feb, said that I would have to cover 20% of the sleeve surgery, but today the rep said I wasn't covered at all for anything and there were no notes about the previous rep I spoke to. Because of my income I can get on Medicaid in Pennsylvania. I have been paying for insurance out of pocket, because I like my family doctor and I didn't want to have to go to a clinic. However, the surgeon's office said that it will be covered 80% and there maybe other things like the hospital that won't be covered. Has anyone in PA used medicaid for a sleeve? Did anyone in PA have a Highmark policy that covered surgery? I'm not sure if I should go for Medicaid or upgrade my policy to something that covers bariatric. Any other suggestions/help? Thank you!

My surgeon's office confirmed that all 15 individual plans offered by Highmark in PA do not cover bariatic surgery. I really wish someone would have clarified that this is the case with most individual plans, and for coverage you need to essentially have insurance through an employer. I'm going to have to apply for Medicaid in light of this new info. Hopefully it will process quickly and won't affect the 5 months of classes and appointments I've already had.

Thank you NikkiDoc. I did look at my hard copy of the plan and bariatric surgery was listed under excluded services. However, I'm going through all the available plans for Highmark and so far all of them have bariatric surgery under the excluded list. I was under the initial impression that it would be covered depending on how the dr coded the procedure. Can I call Highmark and ask them if they have any plans that cover this? Or would that make changing a plan impossible? This is the main thing I am unsure about. I am going to call about Medicaid this afternoon. The only thing that worries me is that I was told it will take up to 30 days for them to process my application. Also that I loose the options I have now with the insurance I pay for myself. Such as seeing my primary care physician.

Thanks Marisa! Were you initially approved because your plan did cover surgery? Mine is now listed under exclusions, however I was under the impression that the way the dr would code the procedure could override it being listed a an exclusion. Which I guess was completely wrong.

Thank you for the links jersrose! I was going to pull out my hard copy of the plan when I got home to double check. I was under the initial impression that the way the surgery was coded would override exclusions listed as such. I will look into the Medicaid link you shared as well. I just wish it would be easier to see all of highmark bsbc plans to know if any of them would cover it. But their website is very counterintuitive. Which I assume is on purpose.

Hi Marisa, I was just wondering if you had any updates with your insurance? I have Highmark Flex Blue PPO 1000, and just found out from the 2nd rep I spoke to that a sleeve wouldn't be covered. I was just curious what plan you have and if you found out that you are covered?