TIF and BlueCross

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Regular Member

Date Joined Apr 2011
Total Posts : 377
   Posted 1/25/2012 7:19 PM (GMT -6)   
I just learned that BlueCross MA has added TIF to its list of endoluminal procedures that it excludes. I seem to be running out of luck with any solution I am trying to seek!

Some surgeons and GIs etc. are lobbying to get them to not do that - but not sure if/when they will change their policy. Apparently, because so many earlier endoluminal surgeries / procedures (Endocinch, Stretta, injections etc.) did not give good results, they are doing this. However, I think they've probably done their analysis and have figured that even if Nissen costs more, since it is more complex - fewer patients would want to do it and therefore their costs will be lower compared to if they also included TIF which although costs less - but more patients would want to do it.

Tandem Rider
Regular Member

Date Joined Jun 2011
Total Posts : 122
   Posted 1/25/2012 7:59 PM (GMT -6)   
Surprised to hear that BlueCross MA dropped the TIF. My Anthem (BlueCross in Indiana) paid for my TIF last April.

Sorry that it did not work out for you.

Regular Member

Date Joined Apr 2011
Total Posts : 377
   Posted 1/25/2012 8:13 PM (GMT -6)   
Yeah .. kind of tired of finding an end to this madness ... just seems like I am spending way too much time on this thing.

Anyway .. we haven't given up on it though. We will make our case to the insurance folks and see what they have to say.

Regular Member

Date Joined Nov 2011
Total Posts : 417
   Posted 1/25/2012 9:32 PM (GMT -6)   

I had the procedure covered here in Florida by BCBS, although there is apparently still one procedure code my surgeon is trying to get reimbursed for. I suppose it's possible that BCBS changed the rules mid-stream when the charges were being submitted.

I'd mention this to your doctor, and it's possible he can submit the charges under a different code. I recall that my surgeon used a "miscellaneous fundoplication" code or something like that, because he said that there wasn't a specific code for the TIF yet. Maybe what he was trying to tell me was what you are finding out, but all I paid was my deductible, and everything went according to plan.


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Date Joined Apr 2007
Total Posts : 32602
   Posted 1/26/2012 9:54 AM (GMT -6)   
Good Morning,
I am sorry to hear you have run into a glitch as I know how frustrating that can be. We have BCBS of MN and medications have been our biggest frustration. 
I believe that BCBS is different in each state as to what procedures it will pay for as well as policies can widely vary.   
Good luck on your appeal and do let us know how you make out.
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