Question:
what are the requirments for bc/bs?
i have been trying on and off for the bypass surgeryfor 4 yrs. now, I have also changed insurance (aetna who denied me due to the 5yr consecutive obesity becaus in 03' I was on a crash diet and fell right under the line). I havebeen marriedand on my husbands bc/bs for 5 months,his mother had the surgery through them in 2005 with very little trouble and I have many more health problems then she did.Any advice on dealing with the insurance devils?CristinaV — luvbug0218 (posted on January 14, 2007)
January 14, 2007
my advice is to let your surgeon's office handle it. if he has a good staff
they will know how to get you approved quickly or at the very least what
requirements have to be met for which surgeries and whether or not the
exclusions can be appealed or how to get around them. aetna does deny on
first try as most do. additional medical diagnosis' are also required when
trying to obtain approval.
— _blue_
January 14, 2007
I concur. Your doctor should have a relationship with BCBS and should know
how to get you approved. As long as BCBS covers wls and you have
co-morbidities or a 40 BMI you should not have a problem getting covered.
In my case, I have Horizon BCBS (NJ) and my doctor got me approved after
the psych and nutrition evaluation! I did not have any out of pocket
expenses (deductibles) because my doctor and the hospital accepted what
BCBS paid. If your doctor doesn't want to get you approved, look for a
different doctor.
— Sheri A.
January 15, 2007
I have BC/BS of Iowa - Alliance Select. The requirements in my policy
are:
*40+ BMI for 3 years or 35+ w/comorbidity or 50+
*3 yrs medically supervised diet or 3 yrs medical supervision of
comorbidity(s)
*Psych eval
But that's just my policy, most policies have slight differences and some
employers opt not to include WLS in the plan.
The HR department of your husband's company should be able to give you a
copy of the policy.
— jactkb
January 15, 2007
I had Horizon bc/bs of NJ and they approved my surgery right away. I had
what I thought were NO comorbidities, but my surgeon's office came up with
all kinds of things. Let them submit the paperwork......they know what to
say.
— barefootgirl
January 16, 2007
I had no problems with BC/BS approving me for my first surgery (lapband
10/05) but did have problems with amerihealth for a revision to RNY in
august 06. i found my doctors office to be to busy and aggitated when I
would ask my status, so i started bugging the insurance company myself. the
more i called, at least once a week, the higher person i got to deal with
until I got to the top. It worked for me, i am one month post op now and
have lost over 20 lbs already. sometimes it is worth being a pain in the
b--- if it gets you what you want. i dont usually act like this but it sure
worked for me. best of luck to you, you really should not have a problem
with BC/BS.
— noboat4u
January 16, 2007
I have not had my surgery done yet but I have BC/BS Federal and so far have
not had any problems. I have a BMI of 35 and looking at Lapbanding. The
staff at my doctors office handles everything with the insurance. They
know exactly what to do and how to submit the paperwork for your approval.
I was approved within 2 weeks. Good Luck...
— Karen M.
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