Insurance Question

I wsa just wondering how many of you that have had surgery, have BC/BS Community Blue PPO and how long it took for you to get approved. It sure is a confusing process. When I call the Insurance company I always get a different answer on things. No one will send me anything in writing and its very frustrating! Any advice or personal experience would be GREATLY appreciated!!! THANK YOU!! Marlo

My approval with BCBS PPO took less than 2 weeks. I had a lot of problems so I was well qualified for this surgery. I never called the insurance company directly. Hopefully your surgeon's office is handling everything for you. Any other questions please let me know. Suzanne 300/152

Thank you for your response. I hope you dont mind if I ask you a few more questions. When you said you had alot of problems, what were they? I dont mean to get personal but I'm just anxious and curious. Personally, I have high cholesterol, high blood pressure, NASH which is a liver disease with chronically high liver enzymes and sleep apnea. Plus I've tried and tried to lose weight to no avail. I lose 10 and gain back 15 etc... My regular doctor wrote a letter to my surgeon stating I've gained over 50 over the past 4 years and developed all of the previous health issues during those 4 years. She sataed we have talked virtually at every appointment about my weight and diets and exercise etc... But I've been told by quite a few people you have to also have like Weigh****chers or medical weight loss center documentation. I'm just curious to your opinion on this. By the way, congrats on your accomplishments! You look awesome!! Half the size you were!! I can only pray for that one day! Thank you again for replying to me. Hugs, Marlo

I had high BP, aritithis, bad back, heart problems, borderline diabets, and I suffered from sometimes severe boils. I had tried with weigh****chers and did not have to show documentation but my dr kept good records and wrote in my chart about my attempts. My PCP filled out a form but I do not know about submitting a letter. I did not really have to do anything. If you always disuss it with your doctor and notes are taken I dont see a problem. That is my opinion. Thanks for the congrats. I have worked my tail off to get this size, it has not come easy. It is still hard work and sometimes the demons can still play a part in our lives although we had this surgery. I hate to hear people say that this is an easy way out because it is not. Suzanne

Thanks so much for writing me back. From your experience I think mine goes the same. I guess at this point I'm a bit obsessed about the aprroval because that is the only thing holding me back. I have to agree with you on people who say this surgery is an easy way out. WHATEVER! Those are usually the people who've never had a weight problem to begin with. When anyone says that to me I invite them to attend a seminar on the surgery with me, assuring them that there opinion would change real fast!! This is going to be the hardest thing I've ever had to do. But thankfully it is an option and will help me get healthy again. I hope you are having a good weekend in this gorgeous weather! Talk to you soon! I'm going to go out for a walk in a little bit. Marlo

HEy Marlo! I have the same insurance and if you go into my profile (I believe it is the March 16th entry) I have a letter my PCP wrote for me that was submitted to insurance.........That was the ONLY thing I needed to get approved. Hope that helps some Jennifer 355/264/150

I have BCBS PPO as well. I received a list of questions from Hurley Medical Center that I needed to call and ask my insurance company. It had specific procedure and diagnosis codes on it .... when I spot to BCBS, they were able to give me detailed information about approvals, requirements and pre-admission testing coverage. I also verified my deductible and total out-of-pocket costs while I had them on the phone. You might want to contact your doctor to see if they have something similar that you can use to ask specific questions. The only thing I'm concerned about at this point is the diet history requirement. My insurance requires 12 consecutive months of doctor supervised dieting. I don't meet that requirment (I only have 8 months). HTH, Pam

Pam that was my requirement too and I did not have any documented history ( well recent enough for it to be used) and the letter my PCP wrote covered all of my bases. Because there is no pre approval, my surgeons office knew EXACTLY what the letter needed to state in order for blue cross to pay. I got my copy showing where they paid 32k so the letter was sufficient enough! Jennifer

Jennifer - Thanks for the information ... heading to your profile now. I spoke to my sister (who is 5-years post-op) and she didn't think the 12-month requirement would be a big issue either. So glad to hear of someone else who breezed through pre approval. Pam

Thank you so much for all your information. I am going to call my doctor tomorrow and see what they have. I dont have the 12 consecutive months on paper but I do have a letter from my doctor about the past 4 years and my attempts and so forth. I guess its just a waiting game now. Thank you again for posting that information. I think its very useful for me Hugs, Marlo