BCBS not paying for my dietician visits

I have a BCBS PPO policy and they have paid for everything except the psychologist (which I was told they wouldn't prior to seeing him), but they did not pay for my two visits to the dietician as part of my pre-surgery testing. Has anyone else run into this? I guess I will call and see if they will change their minds. I know they do not pay for any weight loss program (i.e. HMR, diet workshop, weigh****chers, etc.) but this was part of the testing required in order to have the surgery. Anyone have any input into this? Thanks, Holly

Hi Holly, My BC paid for the dietician--a few times now in fact. Maybee it is the way it gets coded. DId you get referrals prior to --I did need these. As far as the psych consult-I had to call the # on the back of my card. It was Magellen that takes care of the psych. They issue the refereral. How it was handled at Brigham is that the Brigham Physicians group needed to bill--not the specific doctor. I hope these tips can help--call Blue Cross and ask them for help with the dietician codes. then see if there is a psyc tel# on the back of your card. Joan F.

Thanks Joan. I don't need a referral becasue I have a PPO but I will definitely check on the dietician code. I'll keep you posted. Thanks again. Holly

Hi Holly, The billing must have been incorrect. BCBSMA does pay for nutritional counseling. They need to bill it as pre-op with morbid obesity as the diagnosis. Maura

Thanks Maura. That will help me immensly. Hope all is well with you. Holly

HOlly, I have the federal plan and they wont pay for anything obesity related. If you have a dianosis of diabetes you can try to get the hospital to code it as diabetes related. But I do have to pay for the Nutritionist as well.... and I am at a prediabetic state. Theresa

I have BCBS Federal PPO, and they paid for both mine and my husband's surgery, as well as all pre-op testing (dietician, psychologist, ultrasounds, ekg, bloodwork, etc.).

I just tried looking at the benefit book to verify that and to lead you to it (online, on fepblue.org) but couldn't find the pdf that they usually have on it. If you look at your benefit book, it states that you have to be at least 100 pounds overweight, or be less than that with co-morbids. I have the Basic options plan (not the Standard). I believe my case worker at BC was Elaine, or Eileen (can't remember), but she made sure things happened they way that they should. Send me an e-mail, maybe I can help some more.

Holly: I have BCBS HMO Blue and they paid for everything but the phych. When I was scheduled to see the dietician I was told to get a referral to the medical physican and it would be covered. I think it is a matter of your hospital working with you. The dietician was under the Physican's supervision. Hope this helps john

Thank you all for your input. My BCBS is the medical part of the National Elevator Industry Health Benefit Plan (NEIHBP). I called the number on the back of the card and asked a rep there why they wouldn't cover it as I had been approved for WLS and the dietition visits were required protocol for pre and post-op surgery. He looked up my records and said that there was nothing in my records that indicated that I had been approved for WLS. I told him I had a letter of approval and that my surgeon also had the same letter and they had called me to tell me I had been approved. He said, well your records don't show it. I freaked out!!! I called my Dr. Hess's office and spoke with Maria, his Program Coordinator and she told me that of course I had been approved as she was looking at the letter. She gave me the phone number on my Pre-Cert. and when I call I spoke with a terrific woman who said, yes, of course I had been approved. She said she would send the letter out again to me and everyone else connected with my benefit plan. She faxed me the letter and I will wait until Monday before I call the "nasty" man back (NEIHBP). I am all set to fax him a copy of my approval letters and then see if my visits to the dietician will be covered. I am assuming they weren't covered because the NEIHBP did not have notice of my approval for the surgery. Maybe it will work, maybe it won't. I can deal with anything now that I know I was definitely approved. It was an emotional couple of hours before I got it straightened out. I will keep you posted. Once again, thank you for all your responses. I only went on like this because if anyone else has the same insurance I do, they may learn something from it. Yours in WLS, Holly O.