BCBS CB PPO Question

I've posted this on the insurance forum too, but thought someone here might know the answer too......... The company my husband works for is changing to BCBS Comunity Blue PPO insurance company Sept. 1st. He spoke face to face to an ins. rep about coverage for GBS and the rep said it is covered. But hubby didn't ask much of anything else. Does anyone know if BCBS Comunity Blue PPO insurance requires a waiting time for GBS RNY surgery after enrolling? Example; must have coverage for 12 months before submitting for surgery coverage. Thanks, Cynthia

Hi Cynthia, I have BCBS-Messa. I am not sure if there is a difference in BCBS Comunity Blue PPO. But I thought I would tell you about my experience with BCBS. They covered mine at 100% and I had about a 2 week waiting period for approval. They did not require a 12 month waiting and dieting period. I believe that is Blue Care Network that requires a 12 month waiting period. I had to have a cardiac clearance, phsyc eval, sleep study, and nutrition classes. They did require my PCP to write a letter stating that the surgery was a "medical need." Now I am not sure how much the plans differ so someone else may be able to help you with that but I thought I would let you know my experience with BCBS. Best wishes! Kathy

Hi Kathy, thanks for responding. I guess I'll find out for sure in a few days, we get all of our paperwork tomorrow. I do have a few things already, from the first time I tried to get approval from the "old" insurance; my letter of support from my PCP, done, (current letter) sleep study, done (dang sleep apnea!) phsyc eval (prolly have to redo, my letter is 2 years old) So, I guess I have to play the hurry up and wait game. Cynthia

I have BCBS PPO Community Blue and it covered my surgery. I had to have a psychological evaluation and I had to provide documented records that I had participated in at least 12 months of a doctor-supervised weight loss program within a specific amount of time (can't remember how many years, it was 2 or 3). I also had to provide a letter of support from my PCP.

Thanks Karen, I have some of those, but others I'll need to do yet, I'm not sure about the 12 month diet thing, I have done it, but I think it was 2 to 2/12 years ago. I'm going to take everything I have from my last try to my consult and see what they think/say. I appreciate your responses. Cynthia

Hi Cynthia, From what I understand, BCBS is one of the easiest to get approved. I have BCBD PPO. Part of my diet history was a letter from Weigh****chers saying I was a member for a year but had lost my weigh-in booklet. I had about 4 months of Dr visits documented too. If you'd like a copy of my WW letter I'll be happy to fax it to you. Rachel