has ANYONE been approved through wellmark bcbs

[hurryupandwait 0]

wondering if anyone with bcbs wellmark of Iowa has been approved in any case or with any appeal?

[WeekendWarrior 0]

I just called my Dr. office and and asked them if they have heard if Wellmark is covering the sleeve yet.

Their insurance person said that there is supposed to be an annoucement next week some time.

[ShellieB73 0]

Is there some concern that if the policy changes that it won't take effect until January 1, 2011. Is the general feeling that the policy will be changed? Lord have mercy........

[journiewilde 0]

Marking the thread for myself... I'm also very interested in this 'announcement'!

[WeekendWarrior 0]

Looks like wellmark is covering the sleeve as of today.

LINK

Sleeve gastrectomy, as a stand-alone procedure or when combined with a malabsorptive procedure, may be considered medically necessary for patients meeting the above general criteria and one of the following weight criteria:

•BMI ≥ 40 kg/m2 for at least 3 years

Or

•BMI ≥ 35 kg/m2 in conjunction with one of the following:

◦Hypertension requiring medication for at least one year

◦Diabetes mellitus type 2 requiring medication for at least one year

◦Obstructive sleep apnea, confirmed by a sleep study, which does not respond to conservative treatment

◦Documented cardiovascular disease

◦Pulmonary hypertension of obesity

AND one of the following:

•History of transplant, i.e., any solid organ or allogeneic or autologous stem cell

•Chronic corticosteroid use

•Anti-platelet therapy, i.e., aspirin, Plavix® (clopidogrel bisulfate), Ticlid® (ticlopidine hydrochloride), Effient® (prasugrel)

•Inflammatory bowel disease

•History of gastritis or peptic ulcer disease

[WeekendWarrior 0]

Looks like they are a bit more restrictive on who they allow to have the sleeve.