BCBS

Hey y'all----here's the deal.  I was wondering if anyone has had similar experiences with BCBS of Mississippi.

I live and work in Texas, but my insurance is BCBS of MS because my employer (BancorpSouth) is based out of there.  My surgeon's office sent in all my pre-approval requirement info (psych eval, dietician visit, medical records for the last 5 years showing obesity, i have a BMI over 40, i've done the failed diet attempts by visiting a doctor every month for the last 6 months, met with my surgeon for the first time, etc). 

So.....been waiting almost 3 weeks now, called the insurance.  They told me they don't do approval letters.  All they can do is send the medical policy guidelines to the surgeon and as long as they follow it and I meet the requirements, they'll cover the surgery as outlined in my policies.  It sounds like bull to me because I want them to say beforehand "we approve this.  you've done what you need to.  we'll pay for this."  But the only answer I'm getting is around those words.

Anyone experience anything like this with BCBS??

BCBS of MS won't touch weight loss surgery.

BCBS of MS will only pay for gastric bypass if you meet all the criteria - medical necessity, diet, nutrition, etc. It will not pay for lap band because it is deemed an "Elective" surgery.

AND - BCBS of MS will only pay if you have the government insurance through them. Bancorp South would not fall into that category. So you are out of luck I'm afraid.

I hope you get the results you want, in spite of the negative responses to your question.

Good luck!
Tammy

That's what I had heard, but my surgeon and I checked on it and my policy covers the surgery (lapband, bypass, or the vertical banding).  I want to go with the roux-en-y bypass and I've done all of the pre-requirements.  I guess it's just more of a waiting game now.

Have you checked your policy to see what it specifically lays out?

https://www.bcbsms.com/index.php?q=view-benefits.html

This might be the best route to go. It's definitely something in writing and will give you a little more direction hopefully.

Good luck!

Tammy

thanks!

I have Federal BCBS Mississippi and it paid for most of my RNY.  I think all I paid was around $400.  Three years ago Fed BCBS would only cover RNY, and the next year they added lap band.  But they would not send a pre-approval letter to my surgeon's office. I didn't have to do the 6 months of dieting, but I did have to prove that I had been morbidly obese for 5 years.  Since I would rarely step on the scale at the dr's office, I asked my surgeon's office if they would accept photos as proof.  My daughter had twin sons in 2001 so I had five years of pictures of myself with them.  You can see how they grew in those five years....and how I grew too!  They accepted the photos but never had to use them.  BCBS paid without question.

Good luck to you!
Pam