BCBSGA pre-approval help!!!!

BCBS of Georgia is going to start excluding Bariatric coverage when your plan year renews. The customer service department wont even discuss bariatric questions as of today. Has anyone gotten a list of requirements from BCBS via your doctor and the approval department? They told me today (when I spoke to a supervisor) that even though my plan covers bariatric surgery that it would be "iffy" if I got approved. Do you think they are just trying to scare me off? Any suggestions

I have heard that they're not going to cover it after the first of the year. I was at a support meeting last month in Gainsville and the doctor said that they may just be going to tell you what doctor you can use. I just pray that the ones of you that still need it can get . Judy

According to what BCBS supervisor says and what our Insurance agent found out for me it is based on when your plan renews for 2005 (my plan runs from May 1, 2004-May 1, 2005) when the plan renews on May 1st 2005 they told me I will not have bariatric coverage. Do you have any idea what all the requirements for BCBS are before submitting your package for approval?

Hi Kimberly, I have BCBS Ga .. had surgery April this year , I got approved the first go round. I would be glad to talk to you .. this would be alot easier. email me with your # God Bless Your Journey, Sheila -96#

OK, here's the deal. BCBS HMO of GA is no longer including WLS as a standard covered benefit. However, they allow the employer to add a rider to the policy to cover the WLS at an additional premium. I've spoken to my HR department and they did not opt for the additioinal rider. Therefore, if my surgery is not approved and not actually done in 2004 it WILL NOT be coverd...there is no grace period. What the insurance companies are trying to do is shift the burden of denial to the companies that we work for rather than the insurance company...therefore if we are mad that it's not being covered anymore, it's not the insurance company's fault because they offer it as an option to the employer...it then becomes the employer who is on the line for law suits etc...pretty smart if you ask me. By the way, you can get a copy of BCBS's basic rationale for surgery online, it was just revised in October...remember this does not mean that it's covered - it's the rationale they use in the event that your specific pan covers it.... https://provider.bcbsga.com/provider/medpolicy/policies/surgery/morbid_obesity.html REMEMBER THE ABOVE IS THE GENERAL POLICY AND IS ONLY USED AS CRITERIA "IF" YOUR SPECIFIC POLICY COVERS IT.... If you want to view your current policy (2004), BCBS of GA puts it online in pdf form...you must go to : http://www.bcbsga.com/ . You register and then you will click on the option to see your companies certificates (the coverage booklet that tells you what is/isn't covered specifically based on your employer's coverage). However, the 2005 certificate probably won't be on line so, you'll have to go to your HR office and ask if they've picked up the rider or not to cover WLS...at this point that is going to be the only way to tell...see, insurance coverages are just being finalized by employers for next year...there is a lot of paperwork ect...the customer service reps at the insurance company are the last to know because of the paperwork trail and having to load EACH employers new coverages for the new year...you need to go to the source - your HR department. Good Luck...If I can answer anymore questions or help walk you through getting your info online just holler! Best Regards, Chris S

I would submit everything like nothing happened. If you have met all the requirements then submit. Afterwards, if you get the run around start writing them and send all informations to the state board as well. Believe me this work. I am there worst nightmare. When you write the state board things happen.

Thanks for all the feed back. Luckily I am the Plan administrator for my employer so I have some "pull" and it looks like since my plan doesn't renew until May 1st 2005 I have until then to get approval and the surgery done.

That's good news! I'm glad you have some breathing room! Best Wishes! Chris S

Yes, I have BCBS The list from my doctor's office states: letter from PCP diet program history for 5 or 6 months (does not have to be consecutive) complete physical chest x-ray medical records There are some other things that may be needed depending on what your needs are, for example other doctors you see regarding your comorbidities or health concerns. I received approval today, and according to BCBS I was approved as of 10-29-04,, but I didn't know or the Dr.'s office. So I would say pursue your claim.

When I called BCBSGA they stated to me that the surgery will no longer be cover in 2005. I have my PCP letter, Dietician, and PHSY so I'm just waiting to get an apt with Dr. Duncan. Good luck!