Question:
NEED HELP TO GET BC/BS TO SAY YES!!!

IS THEIR ANYONE POST-OP THAT CAN TELL ME WHAT IT TAKES TO GET APPROVAL FROM BC/BS PPO I'M 2 MONTHS SHY OF FINISHING MY 6MO. PHY. SUPERVISED WEIGHT LOSS IVE DONE MY PSYCH. EVAL,I'VE BEEN TO THE NUTRITION CLASS,I'VE BEEN TO 2 SUPPORT GROUP MEETINGS,SLEEP STUDY ,PHY, IS WRITING LETTER OF SUPPORT DO I HAVE ALL MY DUCKS IN A ROW?    — awebster (posted on March 14, 2006)

March 13, 2006
I had surgery with Highmark Blue Shield...same co. different name. You're doing everything they require. The doctor's office usually knows what has to be done with each ins. co. Mine had a binder with each ins. co. requirements they made sure they followed.
   — Nicole E.

March 14, 2006
You might also want to start a list of all of the different methods you've tried to lose weight, when and for how long, how much weight was lost, and when weight was regained (as much as you can remember - it's hard to remember it all). That's something a lot of ins. companies require. I've been told BC/BS is pretty reasonable. I wish you all the best!
   — kjoy

March 14, 2006
I had BCBS and they are the HARDEST to get approved through, IF you CAN get approved. I was turned down after several letters and requests for appeals. I had to end up going through another company and waiting almost a year later. I wish you the best of luck with BCBS. I REALLY hope you get it through them.
   — leahrobinson

March 15, 2006
It sounds like you do.... contact your surgeons office and ask them to double check and make sure and to tell you if there is any else you can possible do to feel like you are helping this along. I would also say that you need to keep going to the support groups. The groups are more for your mental readyness than anything. I run a group and let me tell ya... no matter where you are in the process we all need the group support. Even the group leaders. God Bless and God Speed!
   — dchildress

March 16, 2006
I too have BCBS PPO. I had to have twelve months supervised diet though. The letter that my PCP wrote to BCBS had to state that I had 'X' amount of CONSECUTIVE months of dieting. You might want to make sure that your PCP includes the word consecutive, it is very very important. My surgeon sent for my approval for me, and the surgeon wouldnt even send the letter from PCP until it had the word consecutive in it. It sounds like you have done very well in getting everything finished! I hope this works out well for you. Good Luck! Stephanie
   — squeekypete

March 31, 2006
I also needed an endoscopy, a cardio exam and a pulmologist examination to get approved with BCBS of NJ. BUT- they approved on the first time bc my surgeon knew to make me do all this stuff first.
   — penthilisea

Click Here to Return