BC/BS Ga Question

I am new here and in the process of choosing a Dr. for WLS. I have BC/BS of GA Ins (HMO).
Does anyone know what they reqiure before they approve WLS? I am at a BMI of 42.5.
Any help would be great!

Hey. I Have BCBS of GA (PPO). I just had the LapBand surgery. I know there is a huge difference but I've heard alot of other people say simier things. Of course things varie by plan. But my requirments were:
BMI higher then 40
blood work
EKG clearance
Medical clearance
5 year medical history showing obesity
5 year diet history in essay form (what ive done over the past 5      years to lose weight)
Nutrionist Consult
Physc Evaluation and Consult
Also send proof of my type 2 diabetes, PCOS, borderline hypertension, and sleep apnea with cpap

I submitted to insurance on 7/7 was approved on 7/14 and has surgery on 7/29. You should call your customer service line and ask. I did before I even started the journey to see if it was even possible. Which form of WLS are you wanting? Good luck and Best Wishes.

Well, I called my BC/BS this morning (I had called two years ago and they said they covered at 100%, but I chickened out). Guess what they said this morning?........ the group has decided that WLS is not covered so all the bills would be on me!!!! I am so mad!!!   

When I called a friend of mine, she said that if you get a letter from your DR. saying that it is medically nes. they still have to cover it. Do you know  anything about this? Thanks for your help.

We too have BCBS PPO and were told by BCBS that under no cir****tances would our curgeries be covered.  My husband work opted out of that coverge.  My husband said even if the dr says it is medically necessary and she said no.  I have read of there being people who have tried to submit it to BC for approval and they have gone through and been approved but it has taken over 2 years once you see the drs they want you to see and appeal appeal appeal.  God luck with BCBS.  Maybe if we all had chemical dependancys they would be more apt to help.


BTW, my husband and I are going to Puerto Vallarta in November as self payers.   Yeah, it cost a lot more but if I had to go through all of the test and waiting I would surely back out!

Good luck

THIS KILLS ME!!!
I can not believe that wanting to improve my life and health has becomes so much harder!
The INS company is a pain! Where my husband works is a pain!!
I called the Dr office for self pay amounts and we are talking more than $20,000!!
OMG!!
This is more than a new car payment. I just don't have the money to pay $300-$400 a month for 5 years esp.  with the economy like it is now.
What to do??????
I could kick myself for not doing this years ago when they covered it.

I hate that your going thru this!  I have had my issue's with insurance myself.  I have new insurance now so I havent had any problems.  BUT............I always watched that TV show Big medicine, with the father/son bariatric doctors, and I remember one time a patient's insurance said they would NOT cover them, the doctors wrote them, explaining the necessity of the surgery, and they finally relented.

Possibly......being persistant will help, it can't hurt.  I will surely keep you in my prayers!!!

HUGZ
Your friend,
Pam

Sorry about ya'lls insurance. Every plan is sooo different. LIke I said, mine didnt just cover it, I had to prove it was medically neccesary. Theres a doc in Mexico. Dr Ortiz I have heard alot of good things about him, and I hear he is faily good price wise. You could get a lawyer to write a letter and try to appeal. Sorry.

I have BCBS of Georgia PPO.  My best suggestion is to call the number on the back of your insurance card and ask.  They transferred me to a claim specialist who opened a claim, gave me a list of things they required and also gave me the names of local surgeons they work with.

When I contacted a surgeon, I was required to attend a "seminar".  At the seminar (www.emoryhealthcare.org) -- can't even begin to say enough good things about these people, they gave me a booklet with a list of all the various things various insurance companies required.  Basically they are:
 - Letter of medical necessity from your PCP stating your age, weight, BMI and the fact that they feel surgery is medically necessary
 - Document summarizing all previous Weight LOss attempts.  I did this on my computer Date - Diet Program Tried - Pounds Lost -- Pounds gained >> as best as I could remember
 - Letter of medical clearance from PCP saying you are healthy enough to have surgery
 - Psychological clearance
 - Required me to select a program that offered not just surgery but support groups, dieticians and psychologist.  Even though BCBS doesn't pay for the dietician or support group... they required me to participate in them
- Required me to attend a nutrition class - again they didn't pay for it

Emory also required me to have a pulminary (breathing) test and an upper GI to make sure I didn't have any ulcers in my stomach.  Blood work and a few other tests.  They also compiled all the documentation that BCBS required and submitted it on my behalf. 

Good luck on your surgery!

I have BCBS GA POS and was told I have a WLS exclusion policy so no surgery for me w/ insurance. I will be self pay w/ Dr. Aceves hopefully beginning of next year.  Good luck w/ the insurance, they can be a real pain!!! For the people w/ BCBS GA that does cover WLS I think it varies on what they require whether it be months of a doctor supervised diet, providing your diet HX/attempts, etc. Hope all goes well!!