BCBS State Employee Obesity Pilot Program
Recently, we at the South Carolina Obesity Surgery Center received a briefing on the pilot project to cover weight loss surgery for one hundred patients enrolled in the state employee health plan. These one hundred patients would be spread across the state based on directives from the state legislature, with about 22 living in the Midlands. Patients from underserved areas of the state would also potentially be directed to the Midlands by necessity. Patients will be enrolled in the pilot based upon a “first come first served” mandate.
Please understand that while we are specialists in weight loss surgery, the final decision on who will be granted the entry into the pilot program will be made only by Blue Cross/Blue Shield State Health Plan (BCBS SHP) officials. We will do our usual due diligence in advising surgical candidates as to the most appropriate surgical procedure for them. This information along with the required documentation (please see blow) will then be submitted to BCBS SHP officials for final approval or denial. Appropriate candidates whose applications are complete will be sorted by the designated counties and be accepted on a “first come first served basis” based upon the date that the completed application is received by BCBS SHP.
We are currently seeing patients to begin the application process. The start date of the pilot program is January 3, 2011. That is the first day that BCBS will accept potential applicants. Only completed applications meeting all of the criteria have a chance of being approved. If you are interested in being considered for the program, there are three things that you can accomplish through your primary care physician before January 3, 2011:
- See your primary care physician. He or she will need to document that you have participated in two structured weight loss attempts (e.g. Weight Watchers, Physician's Weight Loss) for three consecutive months each, specifically for dietary instruction and exercise recommendations to assist in your weight loss efforts. Then have him/her write a letter of medical necessity in support of your desires to have weight loss surgery.
- Have a mental status exam by a psychologist/psychiatrist demonstrating your competency to successfully participate in a program that will be a life altering event.
- If you have risk factors for heart disease (such as diabetes, hypertension, family history of heart disease) ask your primary care physician to refer you for an evaluation by a cardiologist to determine your risks of undergoing a surgical procedure under general anesthesia.
We recognize that this is not a perfect plan, however, it is an opportunity to prove to the SC legislature and State Budget and Control Board that, with appropriate surgical intervention, not only can we save lives and improve the lifestyles of morbidly obese South Carolinians, but we can also do it in a manner that will save the State the expenses currently incurred by covering the multitude of medical problems that exist solely because of the obesity. A few examples are: diabetes, hypertension, sleep apnea, and gastroesophageal reflux disease.
We cure morbid obesity with a surgical procedure every day. When you get rid of morbid obesity, you get rid of other medical conditions, improve health and decrease healthcare costs in the long run.
We look forward to meeting you the first week of January, 2011. If you have any further questions please contact Trisha Bacon, 803-791-2828
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Letter of Medical Support for Bariatric Surgery
(Download PDF)
Bariatric Medically Managed Weight Loss Program Form
(Download PDF)