Question:
Anyone have problems getting approval with BC/BS of New Jersey for RNY
— k_ibarra912 (posted on October 30, 2008)
October 30, 2008
The lady at the insurance told u she was just kidding?
— Tammi Sandoval
October 30, 2008
I am so sorry to hear about the run around you seem to be getting from your
insurance. I have BCBS of Maryland and did not have a single problem but I
think it depends on which plan your employer has rather than the insurance
company although I am not sure. Good luck to you!!!!!!!!!
— BJWood
October 30, 2008
Hi, I have BC/BS of New Jersey PPO and I had to do the 6 month weight
management classes, my surgeon told me I would need a support letter from
my Primary Care Physician along with a letter (PCP) stating I have specific
issues (hypertension, diabetic, etc.). I also had to submit a letter from
PCP stating I have been obese for five or more years. The only thing you
stated that I did not need were the photos. I hope everything goes well
and Good Luck!
— [Deactivated Member]
October 30, 2008
Questions like this come up over and over again on the boards and the only
answer anyone can give is that every insurance policy even within the same
company varies as to what is required for approval. You can have 200 people
covered under BCBS and there can be 200 different policies all with
different requirements. Your surgeon's office should be very well aware of
this and should not be telling you that what the insurance company is
asking you for shouldn't be required. You're at the mercy of them right now
if you want your surgery paid for and if they say you need X and X, then
you need to give them X, X, and throw in another X just to cover all your
bases. Also, what people do not know is that many contracts have
"staged" requirements in order to get the approval for the
surgery. So for example, the first stage is to complete the 6 month
supervised diet. If you don't then you're denied at that time. If you
complete it, then you're approved for the next stage which may be
submitting all the documentation that they're asking you for now. After you
submit all of that, they'll review it and may approve or deny you for the
surgery or ask for something additional such as a psych evaluation, so on
and so on.
I was a benefits analyst for more than 10 years with BCBS and Guardian
Insurance so I know what I'm talking about. Do not let your surgeons office
tell you what is or isn't required. They're not the ones making the
determination, the insurance company is and what really pisses me off is
that some of these people in the surgeons offices end up screwing things up
for people like you by giving out completely incorrect information on
policy requirements. I can only imagine the number of people that have been
denied for surgery because of information like they gave you.
Good luck!
Valerie
— [Deactivated Member]
October 30, 2008
i have bc/bs of alabama. so it could be different to some extent. how ever
the drs offices are so use to doing this everyday, i f you will be fine. if
they deni , you just resubmit. but, i haven't heard of any body lately have
trouble. i am sure with todays insurance, there are some pretty stupid
excusses. take the list to the doc's office and they will get you though
it! i had no problems and didn't do any of the work myself. good luck
— peggy R.
October 30, 2008
Hi Kimberly, That list is a pretty common list actually. I think they do it
for two reasons; to see what other health issues are a direct cause of
obesity (and can be fixed by GBP). Secondly, to make sure you are serious
about the surgery. I too had to do that 3 years ago, but I ended up getting
approval so it was WELL worth the year it took me to accomplish that list!
Good Luck ! Darlene
— dadebrito
October 31, 2008
I have BC/BS of ILL and I was denied this week. I have submitted
eveerything that is on their critiera. Now they are saying that my 6 month
diet doesn't prove that I truely dieted. Even tho I have all my paperwork
from my PCP Dr. for the last 6 months stating all the required info. So now
its back to the drawing board. I have to get more info from the Dr. before
I can appeal. I don't know what I am gonna get. My paperwork shows all
the info they asked for. So please pray that I get what ever they want.
And if anyone can think of anything that might help let me know. Thanks
— pugsley101
November 2, 2008
I have BC/BS Horizon HMO in NJ. I also went through all the pre-op
requirements and was expecting a problem with approval, but my approval
came just 3 days after my paperwork was submitted by my surgeon. I had my
surgery on 9/4/08 and I'm down 46 pounds and feeling great. Good Luck!!
Don't give up no matter what!
— ssg216
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