Info on BCBS of GA HMO

Okay all you Georgia members who have this insurance. I called them today to find out what they require for the surgery. Long list so be prepared. I spoke with Judy and here are the facts. YOU MUST HAVE SEEN A NUTIONIST AND ALSO HAVE THE PSCH EVALUATION. YOU HAVE TO HAVE A COMPLETE MEDICAL HISTORY FOR 5 YEARS. ALSO, WANT THE SLEEP STUDY DONE. COMPLETE MEDICATION HISTORY FOR PAST 5 YEARS. ALSO, IF YOUR DOCTOR HAS SENT YOU TO ANY OTHER DOCTORS, THEY WANT THEIR MEDICAL HISTORY FOR YOU AND ALL MEDICATIONS. FROM DIABETES, HEART, CHOLESTEROL, ARTHRITIS DOCTORS AND THEIR MEDS. ALSO NEED YOUR MEDICAL CLEARANCE FROM YOUR DOCTOR. WILL NOT COVER LAP BAND. MUST HAVE A BMI OF 40 OR BE SEVERELY OVER 100 POUNDS OVERWEIGHT. IF YOU DO NOT HAVE A RIDER PLAN WILL NOT COVER. UNLESS YOUR INSURANCE RENEWED BEFORE DEC. 31ST, 2004. THIS WAS IMPLEMENTED AS OF JAN. 1ST, 2005. So, any of you who are planning this surgery be prepared. At, least I am in the clear for the surgery still being covered now the next question do I have enough history. Just thought you would want to know.

Thank you Lucretia for getting the infor for us. Now that I have read it, my road ahead don't look so rough. Of course, with GOD on my side, it shall be done. Again, thanks.

Hey Phyllis, Just thought this might help all of us. I know I thought I had everything together. Boy was I wrong. I am glad I called because now I can start getting the other stuff that I didn't have up, so I will get prepared. Which doctor are you planning on using. Just curious. I know alot of people choose Dr. Duncan. I didn't only cause I didn't want to drive to Atlanta. That traffic would be terrifing especially when you have all this to worry about too. Good luck!

I am using Dr. Duncan because of his experience. He has perfomed a lot of WLS's and his location is excellent in relations to my job. For my follow-ups and any post emergencies, his center is less than 4 miles from my job. Again, good luck on your journey.

Hi Lucretia, It's sounds like a lot, however, all you need is to have your PCP write a letter about your medical history and the meds you have taken. I switched from Kaiser to BCBS in July. It took from July 1st to Oct 25th the day I had surgery less than 4 months. Since my PCP did not know me very well I brought him a list of Dr.'s, medicines, every diet I had tried and all my ailments. Then he just sat down and within a few minutes my history was documented. Good luck, Charlene

Lucretia, Great information to share with all the preops who have BCBS HMO. I have the same insurance and I was approved in one week after Ginger sent in my paper work. I had 10 years of supporting documentation of failed medically supervised diet programs. Are you attending the Vitality Clinic in Rome for excercise? and Are you attending the support meetings in Rome? Best wishes in getting approved Tammie G. new loser

Hey Tammie, You asked about the Vitality Clinic and the support meetings. No, I haven't. I do go to the gym here in Cartersville at BodyPlex. I am very nervous. Ginger should have received all my stuff on last Friday, but I have not heard anything yet. How long does it normally take? I have I hope all the documentation she wanted. I also sent in all my diet failures. Is there anything else you think I am going to need to send her. In one of my responses one of them said my medical necessity letter and my clearance letter had to be seperate. Do they? Because if so I am in trouble because he put it in one letter. Please let me know. Thanks

Thanks for the info, I have the BCBS of GA PPO, and also have a portion of what you stated. They did not say exactly how many years and all I needed to have but I think I have it covered since I have records of weight loss attempts starting in 1996....almost 10 yrs worth not to mention all the times I tried on my own. I will have all my stuff completed next Tues and will only be waiting on Dr. Hart's office to get the documentation to the insurance company. Everything is flowing so smoothly it is almost scarey..lol. D'Lynn

lucretia do you have bcbs of ga for the state of ga emplyees. my son works the state of ga prison system and my daughter in law wants the surgery and in not haaving good success in getting approval with the prison system insurance. they switched to uhc hmo and it says it is not a covered procedure. they will switch back to bcbs as soon as they are able to. do you have any answer for me if it is covered or what she may need to do? i had wls in 2003 and had uhc and had no problem. thanks for your help. louise

Hey Louise, We do have insurance for the state. The only answer that I can say is when it is time for them to switch tell your son to ask the represenative. What BCBS told me was the only reason it is still on our policy is because my husband renewed before the end of 2004. That they were not going to cover the insurance any longer unless the company has a rider policy for baractircs. So, you know I think if it is a necessity they would have to cover it. I just hope they will approve me. Sorry, I do not know any more than what she told me. Good Luck to her.