difficulty in getting through to insurance

dancerchick06
on 2/25/14 9:10 am
RNY on 01/07/15

I was curious as to how hard it was for people that read this to get insurance to pay part of their surgery?  How many hoops did you have to jump through? Do I need to be basically on my death bed in order for BCBS to pay for part of the surgery? 

Steve S.
on 2/25/14 10:27 am - Hometown, IL
RNY on 03/17/14

I have BCBS IL and it has been the easiest process.  I called them and asked who was  in network.  Once I found one close, I made an appt. I started this process on 1-29 and my surgery is set for 3-17.  It took them 6 days to approve it.  What does your policy cover?

dancerchick06
on 3/7/14 11:45 am
RNY on 01/07/15

I called and asked what they cover in terms of weight loss surgery and she said once I submit it, they will approve a certain amount. I just wasn't sure how hard it was to even get them to approve it.

 

Thanks

christinamudd
on 2/25/14 12:39 pm

Same here, I didn't even need a referral from my PCP.  I just made sure that my physician was covered and selected my insurance based on that.  Made an appointment, now I am just awaiting formal authorization for the surgery :)

2Weimowner
on 2/25/14 11:54 pm - Spring Hill, TN

I have BC BS TN and I just started this process.  The policy states I have to lose at least 10% of my body weight before surgery (23lbs).  My current weight is 234lbs.  Did any of you have to do that?  I'm so frustrated because I have several comorbities; hypothyroidism, hyperlipidemia, high blood pressure, high cholesterol, metabolic syndrome (prediabetes) and super ventricular tachycardia.

Gwen M.
on 2/26/14 2:05 am
VSG on 03/13/14

I've got UHC and my surgery was approved before I even knew it had been submitted!

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

Sparklekitty, Science-Loving Derby Hag
on 2/26/14 3:07 am
RNY on 08/05/19

I have BCBS Arizona, and my benefit book had a checklist of things that I needed in order for them to approve the claim and pay for it. They needed:

  • 5 years' proof of obesity (via doctors' chart notes faxed to them), including documentation of comorbidity since I was under BMI 40 for a few years (so they faxed over my paperwork for apnea from the sleep center and diagnosis of high BP from the cardiologist)
  • 2 months' medically supervised diet (I made 2 visits to my PCP where they recorded my weight and we talked about what I was eating and how I was exercising)
  • Clearance from a psychiatrist saying "she knows what she's getting into"
  • Approval from the surgeon saying I'm over 18, I don't do drugs, I'll come back for followups, and that I'm healthy enough for surgery.

I was able to get all the paperwork assembled while I did the 2 months' supervised diet, so it really wasn't all that bad.

If you can, log into your BCBS website and download your benefits; there should be information on what is required. The insurance coordinator at your surgeon's office may be able to give you more information as well, since they deal with this often and tend to be familiar with plans used by their patients.

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!

Valerie G.
on 2/26/14 3:52 am - Northwest Mountains, GA

They're pretty well organized about it anymore.  There are some definite hoops to jump through, including being MO for so long, perhaps a doc monitored diet program, or evidence of actively participating in one, a psych eval, etc.  Just call them and ask (1) is WLS a covered benefit, (2) What procedures are covered, (3) What all has to be accomplished before submitting for pre-approval.

Valerie
DS 2005

There is room on this earth for all of God's creatures..
next to the mashed potatoes

tgr1025
on 3/7/14 12:07 pm, edited 3/7/14 12:08 pm

I started my process on Jan 20, 2014 and have been approved and surgery scheduled already. My last appointment was with the surgeon on Tuesday the 18th of February and I had an approval letter in my hand on the 27th of February. In fact it happened so fast that I wasn't able to take work off until April so the only reason I have a delay is due to my work schedule. I thought it was going to take months and months and lots of red tape. I have BCBS as my insurance company.

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