difficulty in getting through to insurance
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?
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
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.
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)
on 2/26/14 3:07 am
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!
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
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.