Blue Cross/Blue Shield of Delaware

Barix notified me today that Blue Cross/Blue Shield of Delaware requires a psych consult, as well as cardiac and pulmonary clearance. For those of you who have BC/BS of DE, how was your experience? Were you approved on the first attempt? If not, why, and what did you need to do to get approval? Regarding the psych consult and cardiac testing, can you recommend any local docs? I can probably get referrals from friends and co-workers, but since most of you have been down this road, I'd like to also have your advice and recommendations. Any guidance you can provide would be much appreciated. Jade

Hi Jade - I have BCBSDE and I had absolutely no problems with coverage. However, I think it depends on the employers contract negotiations with BCBS. I work for the state and they negotiate a pretty comprehensive coverage, while other employers don't. You'll need to refer to your benefits manager or handbook to see exactly what they cover and what you're going to have to appeal for. Good Luck!!!!!

Cathy, Yes, you're right, coverage does vary by employer. I'm glad to learn that you didn't have any problems! Jade

Hi Jade, I had my surgery in Oct 2003. Most RNY surgerons require the psych eval, cardio exams, and pulmonary tests. I have BC/BS of DE. They didn't have any trouble with my approvals but I did have several of the co-morbidities that come with being obese. I use Dr. Brian as my pulmologist, Dr. Weiner as my cardiologist, and Dr. Margaret Keenan did the psych evaluations. I actually contracted with Margaret Keenan for ten sessions prior to my surgery to deal with issue around food addiction. I am very impressed with her strategies and professionalism. Make sure that whoever you use for your test is cleared by Barix, otherwise you might end up having to repeat your tests. My brother used Barix for his surgery, and it is my understanding that they have a comprehensive set of doctors, psychologists, and specialists available for pre-testing. I would recommend using their referrals, especially cardio and pulmo, since those are the doctors they will need to call if somehting goes wrong during the surgery. Good luck, do your research, and go to as many support meetings as you can attend. Rob

Rob, I was under the impression that I could either use Barix's doctors for the "pre-authorization" clearances, or that Barix could provide the referrals, but the email from Barix says I should contact my personal doctor for referrals. I'll contact the office for clarification because I would much prefer to use doctors Barix recommends. Thanks for your recommendations and advice. Jade

Jade, I have BC/BS Federal. I didn't need a psych eval. I had a fairly recent stress test on file that was done by my family Dr. here in Dover, so those results were forwarded to my surgeon. I did have to have an endoscopy done prior to surgery. That was done by Dr. Alexander in Dover. My recommendation would be to use the doctors your surgical practice recommends. Just make sure they are participating providers with your BC/BS Insurance. You don't need any surprise expenses! Good luck! Jean

I have BCBSDE and was approved for a DS with relatively little rigamarole. I, too, had to have a psych consult, and it was a walk in the park. I chatted with the lovely psych for about 30 minutes about my eating habits, what I felt got me to the point of wanting to have surgery, what my motivation was for the surgery aftercare, and did I understand the impact that the surgery was going to have on my life afterwards (duh!). They don't probe deeply into your Freudian childhood issues. They just want to make sure you understand the ramifications of your actions and are mentally aware enough to remember to take your vitamins, eat your protein first, and follow the rules. You'll be fine. I only had to see the psych once, but I plan on going back after my surgery (less than a month now!) for help when I start seeing the changes. That's also fully covered by insurance.

Jade, I have BC/Bs of Delaware. I had my surgery in D. C. but got all my referrals in Delaware. I think this is pretty normal. Your PCP should be able to help you with all this. You have picked a good place for surgery. I have heard nothing but good things about them. See you lighter. Joanne