Very Upsetting
Absolutely; triple check! Then do it again. Go to their website and print off the information. Try bcbs/providers to find the medical policy. I have horizon bcbsnj, and if I hadn't done the work myself, we wouldn't be moving forward to get my approval.
When I had my initial doc visit, they told me my insurance didn't cover bariatrics, but I knew they were wrong. They stood there and argued with me about it, and told me they have a "broker" do all their insurance clearances. I told them they needed to fire their broker! Ended up having to do a conference call with the doc's office and my insurance before it got straightened out. Then, the day before my psych appt., they called and said they don't take medicare. They argued with me that I have supplemental medicare, not regular insurance. Really? After another conference call, it's all straightened out now, but what a pain in the butt! You have to stay on top of it and keep in close contact with your insurance. I plan to call my insurance company to confirm information every time I hear from the doctor's office. Good luck!
When I had my initial doc visit, they told me my insurance didn't cover bariatrics, but I knew they were wrong. They stood there and argued with me about it, and told me they have a "broker" do all their insurance clearances. I told them they needed to fire their broker! Ended up having to do a conference call with the doc's office and my insurance before it got straightened out. Then, the day before my psych appt., they called and said they don't take medicare. They argued with me that I have supplemental medicare, not regular insurance. Really? After another conference call, it's all straightened out now, but what a pain in the butt! You have to stay on top of it and keep in close contact with your insurance. I plan to call my insurance company to confirm information every time I hear from the doctor's office. Good luck!
It seems quite odd that they don't approve VSG below BMI of 50. My program (and most others I've heard of) will approve you if your BMI is 40 or higher, or will approve if your BMI is between 35 and 40 with one or more co-morbidities.
Please speak with someone in charge over there to verify what you were told.
Please speak with someone in charge over there to verify what you were told.
Height: 5'5" 2 wks pre-op: -15 M1: -20 M2: -18 M3: -12 M4: -13 M5: -8 M6: -10 M7: -2 M8: -10 M9: -4 M10: 0 M11: -3 M12: -3 M13: -14 Start Wt:290 SurgWt:275 (BMI 46) Current Wt:145 (BMI 24) Goal:140 (BMI 23.3)
The BCBS national standard is 35 with at least two comorbities and 40 with none. That being said, your individual plan may have different guidelines. I would suggest that you call again, then take that information to your HR and have them look up the plan specifically for you. Just because the insurance company will approve at a specific level, doesn't mean that your plan adopted those guidelines.
Thank you for all your responses. But its right....the doc says he doesn't agree and its ridiculous but its my companies guidlines for approval. He said it could change if I wanna wait a couple of yrs...but what if it doesn't? So at this point its RYN or nothing. If u were in my shoes...would you take the choice given or not do it at all? I wasn't scared about having my stomach taken out but having my guts re-routed scares the crap out of me. Thanks again for all the input!
Unfortunately, companies can have different details than the general BCBS guidelines. I would triple check, for sure, but it's possible. That said, make sure no one is confusing the DS with the VSG. I have BCBS too and it was the DS that required a 50 BMI. And personally, I would likely have gone with the RNY if in this situation. Not sure if that will be the popular response, but I was at a point where I needed to make a change. best of luck.
HW: 280 SW: 243 
I have BCBS of Illinois and I didn't have to wait at all. What's funny is I called them twice and got two different answers. I would try out a new doctor to see what he says. I know you don't need a 50 BMI for the sleeve because I was a 41BMI. Keep pushing. Choose a doctor who has a staff that does the insurance for you because they will know most of the company plans. Keep at it. I'm about 7 weeks out and feel great. .
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