Question:
Is Blue Cross just stalling at this point?
My surgery date is 6/29/01. All my pre-op testing is complete except for the endoscopy/colonoscopy on Tuesday and the final blood work, etc. on Thursday. Passed all tests with flying colors. But I still don't have approval! I have a very high BMI, several co-morbidities, but no answer from Blue Cross of CA; I using the PPO/POS portion of the insurance. Yesterday, my surgeon's office insisted on speaking with a supervisor; she was told that my case is "under review" and that we should have an answer by Tuesday, the 19--10 days before the surgery date! I'm a neophyte at this insurance maze. Do you think I stand a good chance of approval at this point...or of denial? I started my tests in early May; my surgeon's office first sought approval from insurance over 3 wks ago. BTW, Blue Cross' Medical Policy says they cover medically necessary RNY and our policy, through my husband's employer, says the obesity exclusion does not apply to the threatment of morbid obesity--no mention of surgery. Thanks so much! — CaseyinLA (posted on June 16, 2001)
June 15, 2001
I have BCBS of Il and I was told they have 30 days to decide and all cases
go to the medical review board which meets every 2 weeks. I have mine
through my husband's union so they then after holding it 30 days decided
the union needed to review it. The union then held it for 30 days. It took
10 weeks from my initial consult, but finally my approval came.
— Judy K.
June 16, 2001
I have BC/BS of Ala PPO and they told me that it would go to medical review
board and takes 30 days for decison, well they requested more info, sent
more gave 30 more days to wait, then ask for more info and 30 more days to
wait, but finally in the end, all the waiting paid off!! I was approved,
but they would only approve for OPEN RNY and not the LAP RNY!! There is not
a listed CPT Code and we had to send in a CPT Code of unlisted LAP RNY and
they would not approve!! I think this is an attempt by them to get people
not to have this surgery since it's open and takes a little longer to
heal!! But not me!! Hang in there!! In GOD's time, you will be approved!!
Good Luck!!
— SANDRA D.
June 16, 2001
I have BC/BS of AL, too and they give the line about 30 days, blah blah,
but it took 3 weeks to get approval. My doctor would not schedule a date
until we had approval....my surger is 6/27!!!!!!! :-) Hang in there!!
— Sharon N.
June 24, 2001
Thanks to everyone who posted feedback here; you've helped me tremendously!
Update: on June 19, Blue Cross finally deemed the surgery as
"medically necessary" and agreed to pay for it. So I can keep my
June 29th date! = >
— CaseyinLA
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