Insurance approval process for Gastric Sleeve (Blue Cross Blue Shield)

So, I finally went to see a bariatric surgeon to see if I am a candidate for bariatric surgery. Going in I wanted to ask about gastric bypass but the surgeon suggested I get the gastric sleeve since I am in overall good health, except for the obesity. He says since I'm not on any medications for diabetes or high BP, a gastric bypass would be too drastic.

 

Anyway, now I am in the process of going through my checklist of things to do before I get approval from my insurance. I have blue cross blue shield. Anyone else have this insurance? Did you have any issues with getting approval?

 

Some of the things it asks for kind of confuses me? The medical consultation/recommendation...is that a letter stating that a DR thinks I need the surgery? I was also wondering how the psych evaluation goes? do they ask about your life? Just eating patterns?

 

anyway Ill take any info I can get. Let me know how your experience was like. Thanks!

Hi, I have Blue Cross/ Blue Shield. I went through the process and I was approved with no problem. I consulted with my physician and also with the nutritionist. I think they handle all the paper work such as recommendation for surgery. It may differ from state to state, but I began the process in April and was able to have my surgery mid July. The psych exam focused mainly on your relationship with food (for example do you have a food addiction etc.). My psychologist explained to me that if you have a food addiction, the insurance companies may want you to get help before they spend a large amount of money on surgery.

The plans vary from state to state, but I have Carefirst BCBS Blue Advantage PPO, which required

1. Psych eval

2. Proof of 6 months on one structured (but not medical or supervised) diet plan, or two plans w/3 months each (I had 6 months of Weigh****chers online, and submitted the weight logs and the payment receipts)

3. Letter of medical necessity

4. Meeting with nutritionist

The surgeon's office submitted my paperwork on a Wednesday and I was approved on Friday. It was exactly two months from first consult with surgeon to surgery. 

Good luck!!

 

I know this message is from a few years ago, but I'm curious... what did you end up having to pay out of pocket, ball-park? I also have Carefirst BCBS through my husband's employer.

I have BCBS of Michigan...the way my insurance worked was as followed...

1. Went to the weight loss surgery orientation (10/10/13)

2. Insurance requires 6 months medically supervised diet and exercise. I did this with my PCP. (started 10/15/13)

3 Once I completed the 6 months..my PCP gave me a referral for weight loss surgery (completed 04/15/14)

4. Met with the surgeon...(05/14)

5. Did my evaluation..she gave me a ton of paperwork..I was asked just about everything...any time of abuse..trauma...eating habits..emotional eating patterns...when did i start gaining weight...things like that..

6. Met with the nutritionist (05/14)

7. Had to get a chest xray...blood work and an EKG.. (05/14)

8. After all the paperwork was received...surgeon submitted for approval..got approval in about 7 days...

9. Had preop meeting 2 weeks prior to surgery (06/24/14)

10. Had surgery on 07/08/14

 

It does seem like a lot...but everything for me went by pretty fast...

GOOD LUCK on your journey!

 

Hi Jenny. I have BCBS Michigan MESA fir school employees. Here is what they required of me:

1. 6 month medically supervised weight loss program
2. Letter from my primary care physician stating that I am a good candidate for WLS

My weight loss clinic required, through their program:

1. A psych evaluation, which lasted half hour and I basically got asked if I had researched the VSG and if I had support from friends and family
2. An EKG and EEG
3. Bloodwork
4. I didn't need a sleep study because I am on a cpap, but I did have get my original sleep study documentation and my cpap machine pressure number and give it the to weight loss clinic
5. I had to attend 2 nutrition classes
6. I had to go to the clinic once a month to get weighed, talk with a nurse and the surgeon
7. Got binder full of info from nutritionist

Had my pre-surgery meeting with nutritionist, nurse and surgeon on 9/5. Surgery is 9/23.

The clinic submitted the paperwork on a Tuesday and the clinic called me on a Wednesday and said I had been approved.

Good luck to you on your weight loss/getting healthier journey.

Hello

how long was your process from beginning to end?

Hello, I have BCBS also. I am in the middle of going to all these appointments. First, I had to get a referral from my physical doctor. The weight clinic had the letter, I just faxed it to my doctor and had him to fill it out and fax it back to clinic. This is after I had my physical with the doctor. After the physical, I went to an informational meeting about WLS. As far as the psychological evaluation, I did do that. I had to answer close to 400 questions on paper. They were not hard questions, just time consuming. There would be questions like, "Did you love your father? mother? Yes, it does get into personal feelings besides "food". First you have to talk to the psychologist about 20 minutes then he gave me the packet to fill out while I was in the room alone. I turned it in.... takes 2 weeks for them to get results.  Hope this helps. Good luck!

I have blue cross/blue shield, and my process with insurance went very smoothly.  My program was very familiar with the requirements of BC/BS and they took care of it all for me.  I was also very heavy and there was no question that I would benefit from the surgery. 

My psych eval was about stresses in my life and coping mechanisms.  family relations, job, friends, faith, health. It was actually fun to talk about myself for an hour! (smile).  I think they just want to get a sense that you are stable and will be able to manage the stress of the life changes ahead, and if they have concerns they'd help you find a counselor and set up the support systems you'll need.  I don't think its anything to worry about.

best wishes,

Carol

Just letting you know that BCBS does not always make you do 6 months of the dieting. but  I am from Illinois, I don't know where  you are from ..

 

 Good Luck :)