BCBS PPO criteria????
Colleen,
I have a copy of a letter I received from BCBS PPO (Community Blue). I am sure it will depend on the policy you have since they can very by company.
I would call their 800 number and have them mail you this information. Don't let them give you the run around. The person I talked with tried to tell me they did not have a hard copy to mail me...Unfortunately for them I can be very stubborn. They said it could take 45 days for me to receive the letter...I told them NO Problem, send it...Had it within 2 weeks = )
Here is what my letter stated:
Surgical treatment for Morbid obesity is covered if all the following conditions are met:
*patient must weigh at least 250 pounds or be 100 pounds or more overweight
*patient mus be between 18 and 60 years old
*paitient's past medical history must reveal inability to regulate weight with conventional methods
*physician documented failure of non-surgical management including a structured, professionally supervised (physician/non-physician) weight loss program for a minimun of 12 consecutive months within the last 4 years prior to recommendation for bariatric surgery
**documentation should include periodic weights, dietary therapy and physical exercise, as well as behavior therapy, counseling and pharmacotherapy, as indicated
*evaluation performed by attending physician or consultant, needed to establish patient's emotional stability
*additional documentation detailing evaluation, must accompanty claim
*preauthorization not required
Hope this helps,
Jan
Hey Colleen,
I had a dream situation with my BCBS PPO. I called at the very beginning of me thinking of having the surgery, and they said it is something they approve.
I never had a problem after that.
My PCP sent a letter to the U of M program I am in, stating that I was aware of the risks of surgery, and I had been trying many different ways to lose weight. I never had to go once a month or anything like that.
As a matter of fact, the review committee for U of M was much more demanding than BCBS.
I had my surgery in March, and the day I got home from the hospital BCBS called me to ask if I was doing ok, and to tell me I was qualified to have a nurse come out to check my insicions, etc. (I didn't take them up on that offer).
Where are you having your surgery done? I hope you have the same good experience I had.
Brenda
Im just trying to get an idea on BCBS PPO because I have been offered a job and was told this is the insurance plan available to me. Ive heard mixed things on the BCBS PPO, some say it is easy, some say it can be just as bad as the HMOs. Hopefully if I do take this job, it won't be nearly as much of a struggle as I had with HAP. Im still likely going to want to go to HFH for surgery though.
Well, if everything goes well with this new job offer, then I will be getting things rolling again. I will have to wait about 6 months before Im eligible to take time off from work, and at 6 months I can only take 1 week, but since I work at home and have a typing job, I think I could manage going back after a week since I work a split shift and would only be sitting for 4 hours at a time (and I could still get up and move around). Keep my in your prayers. I just want to see this happen!
Colleen