Question:
Has anyone had any luck getting Blue Cross to approve WLS since 11/2004 update?
My surgeon says that Blue Cross has not approved anyone from their office since Oct. 14, 2004. I was denied because of blacked out spots on my medical records, and because my BMI has not been consistently 40 for the past 3 yrs. I have tried to explain to them that I was on a doctor's supervised diet (recorded in medical records) for 1 1/2 yrs. before applying for insurance coverage. I am so frustrated. I have BC/BS Personal Choice. Has anyone been able to get them to approve surgery since 11/2004? If so, how? — Joy B. (posted on March 3, 2005)
March 3, 2005
Sorry to hear you are having such a hard time. I have bc/bs and they
approved mine w/in 24 hours. I was expecting a hard time and got exactly
the opposite.
Good luck to you.
— Splenderella
March 3, 2005
I have BCBS of GA...and my request was submitted on Jan. 28th, I received
an approval on Feb. 11th, and had surgery Feb. 28th. No problems or stalls
at all.
— ~Georgia Girl~
March 3, 2005
Its not necessarily BCBS that is the problem, its the individual health
plan that you are covered by. Some BCBS policies allow for the surgery-see
the other two posters below. I would first check your policy to see if its
covered and if so, call them to see what they require for you to qualify.
— Cindy R.
March 3, 2005
I have BC/BS Federal and I had no problems. The plans differ. My only
requirementwas to be 100# overweight
— Johna H.
March 4, 2005
The reason BCBS of Alabama has not regularly approved since 10/2004 is that
they are requiring a 6 month non-surgical physician supervised weight loss
program prior to approval. You must have completed this program within the
last 12 months. Dr. Christopher should put you on a program ASAP and you
can be approved within 6 months. BCBS of AL will accept Weight Watchers
attendance as long as you follow up with your primary care physcian each
month and they log your weight and loss or lack of loss. There have been
many, many people approved since Oct. of 2004. Your physician must be able
to prove what type of diet you were on and you must have had an appointment
with him at least once every month for 6 consecutive months. If you missed
even one month of seeing the doctor it would result in your being denied.
I know it's so very frustrating but don't give up!! Best wishes!
— ronascott
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