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I do have it, it just isn't very clear on how long you must have the co-morbities...
Okay so I know they're out there, but BCBS says 'search the national provider search', yet it comes up with just 3 doctors, all of which are in Alabama. Now, I CAN drive over there, I'm in Villa Rica and it would be an hour drive. But... it would be an hour drive. If I found the surgeon over there, that'd mean I'd have to endure a 1 hr drive back from there post-surgery. Um, that would really suck!
So I live like 45 minutes west of Atlanta. You'd THINK that there would be a plethora of BCBS PPO providers on this side, but I'm just not having any luck. Does anyone in/around the Atlanta area know of any providers who ARE BCBS PPO okay?
Also, to make the process go smoothly, should I have my PCP submit a request for predetermination now, before I start the 6 month diet plan? I mean, I know the BCBS of AL requirements and I know I meet them, but does it matter if I get the predetermination request submitted before my 6 month plan or after?
I have dealt with insurance companies before, needing approval for surgery (I've had elective breast reduction surgery 10 yrs ago, then had spinal fusion done 2 years ago after 6 years of fighting with them about my back pain). I'm good with meeting all of their requirements. I'm 5'4" and 230-ish lbs, putting me at the BMI range of 39-41 (depending on the day), and a life-long battle with weight loss, plus I have high cholesterol and high blood pressure. I just want to make sure I'm doing the right steps in the right order.
Thanks in advance for any information anyone can provide. :)
- Josie
Do you have a copy of Aetna's clinical bulletin 0157?? That gives the specific requirements that you need to meet in order to be approved. If you go to Aetna.com and in the search box type in 0157 it will bring it up.
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Thanks so much for the input!
Don't let shills sell you the marking term 'center of excellence' as if it's designed around your wellbeing. It is designed around the wellbeing of the insurance company’s uhc’a wallet. Why wouldn’t Boston General Harvard med school training facility be on there or some of the other better university med schools around the country. Use your reasoning. Here is the skinny, no pun intended, if you are outside 50 miles from one of their 'centers of excellence' then you can go to your choice of facility and they have to pay as if it were a center.. Stay informed, do your own research. Pick what you are comfortable with and never listen to people who tell you “you are out of luck “or cannot be done”, they are idiots.
Here is the medical policy for BCBS of Oklahoma Federal Employees.
http://medicalpolicy.hcsc.net/medicalpolicy/disclaimer.do?co rpEntCd=OK1#hlink
Virgie Tschirhart
Lap Band - 2008, Sleeve - 2009, RYN - 2017
Started Program Weight July 13, 2017 - 194.2
Before Surgery Weight December 27, 2017 - 185.0
Current Weight - February 2018 - 161.0
Hi,
Yes, they are very strict when it comes to the restrictions. You have to prove a BMI of over 40 for at least a 2 year history or they will deny. Myself and all three of my kids have had the surgery and were approved through Aetna. Two of us were originally denied and I had to appeal to get approved but in all four cases, we had to prove that 2 year history of >40 BMI.
My daughter was denied at first because she had one office visit where she slipped below to a BMI of 39. She was denied even though she clearly had a BMI of >40 for 4 years. But because of one office visit in one of those years, she was denied. We put together an appeal and simply didn't submit that one office visit in the appeal and she finally got approved.
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
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Hockeymom87 · 0 replies · 858 views
