Blue Cross Blue Shield of MN questioms

Hey Guys!  I am new to this site and am in the beginning stages of my weight loss surgery journey.  I have BCBS of MN through my employer and luckily gastric bypass and the vertical sleeve are covered. (haven't completed decided on which I want)  I have gone over the medical policy that was sent to me from the BCBS but I still have questions.  My main question is what documentation needs to be gathered to present to the insurance company.  I have already gotten my letter of medical necessity from my PCP.  I am in the process of getting my psych evaluation completed and I am in second month of the 6 month medically supervised diet.  Other than the BMI qualifications, which I am more than meeting, these items are the only thing mentioned as qualifications for approval.  However, I have seen other ppl on this site talk about gathering medical records and other items.  I am just curious as to what all I need to be gathering over the next few months.

I have Federal BCBS, not BCBS MN, but I did the same thing as you. I wanted to be proactive and gather everything before I met anyone. Turns out, all I really had to do was go meet with a bariatric surgeon.  They are experts in this area and can tell you everything that will be expected of you, and give you all of the forms and examples of how letters should be written for your specific plan. 

If there is anything they need from you, an experienced bariatric team will do almost everything they can to help you get it. All I had to give my office was my primary care support letter - which they templated and gave to me to have her sign. Mine had to contain certain key words and phrases to get approved. (P.S. approval took about 7 days).

If you haven't attended a new patient seminar, I would suggest you start there.

Thanks so much for your response.  I have met with a bariatric surgeon and his team.  I think I am just overthinking everything and am really anxious about getting an approval when the time comes to submit everything.  When I went to the new patient seminar, they did mention the items they would need from me to get an approval and medical records was not one of the items.  I was pretty much told the same as you.  I was reading other post and someone mentioned the whole medical records thing and it made me wonder if I would need the same. Like I said, I think I am just anxious and overthinking everything.  Especially since I have a 4 months left on my medically supervised diet.  Lots of time to overanalyze.  lol 

Again, thanks for you response.  

PS Congrats on your approval!!!!

Hi lykapal, I was wondering what your reason was for getting the RNY? I too have BCBS Federal. I had the LB surgery in 2008, hated it and the weight I lost I gained back, BCBS Fed did cover it. In 2009, I had a revision from the LB to the Sleeve. BCBS Fed did not cover it, I was self pay. The reason was because I was not in compliance according to my medical records. Just because the VSG surgeon wrote on my record that I would eat when I was stressed out and go for the wrong foods. The sleeve was just not what I expected it to be for me not enough restriction and I guess I needed the malabsorption the RNY has. I have had severe acid reflux because of a Hiatal Hernia that I have had since 2008. I wake up in the middle of the night with acid reflux and am so tired of it. I am hoping that BCBS Fed will cover the RNY for me. Especially because I hear the RNY doesn't give people Hiatal Hernias. I REGRET HAVING THE LB AND THEN THE SLEEVE.

Hi lykapal, I was wondering what your reason was for getting the RNY? I too have BCBS Federal. I had the LB surgery in 2008, hated it and the weight I lost I gained back, BCBS Fed did cover it. In 2009, I had a revision from the LB to the Sleeve. BCBS Fed did not cover it, I was self pay. The reason was because I was not in compliance according to my medical records. Just because the VSG surgeon wrote on my record that I would eat when I was stressed out and go for the wrong foods. The sleeve was just not what I expected it to be for me not enough restriction and I guess I needed the malabsorption the RNY has. I have had severe acid reflux because of a Hiatal Hernia that I have had since 2008. I wake up in the middle of the night with acid reflux and am so tired of it. I am hoping that BCBS Fed will cover the RNY for me. Especially because I hear the RNY doesn't give people Hiatal Hernias. I REGRET HAVING THE LB AND THEN THE SLEEVE

My main reason for the RNY was GERD. I've had severe GERD for years and when my surgeon told me that the sleeve would act like a vacuum and make it worse, I knew RNY was right for me.

With the lap band I had GERD. With the Sleeve I have GERD. I don't think that BCBS Federal will cover the Sleeve to RNY revision because of GERD. Do you know?

Last time in 2014 my doctor's office requested for me the revision surgery the Sleeve to RNY revision BCBS Fed denied me because I was non compliant according to my Sleeve Surgeon's remarks on my record. Also, I had my Sleeve in 2009 and did self pay cause BCBS Fed would not cover the Sleeve.

I wonder if something has changed in their policy now to allow revisions from a Sleeve to RNY because of GERD. I have notice a few people here saying that BCBS Fed covered their revision from the Sleeve to RNY because of GERD.

My weight is just like it was before the Sleeve. 190 lbs. and I'm 5'1".

I really don't know. The best thing to do is call your policy customer service line and ask those questions or go see a bariatric surgeon. They usually know what it takes to get approved by most insurance companies.

Good luck.

I have BCBS of Alabama and I had to provide 3 years of medical records to prove that I had been overweight for 3 years. All I had to do was sign a medical release and that information was sent from my PCP to the surgeon office so that can submit it to the insurance company.