Approval w/ BCN? Anyone?

Hello Michiganders,

I have been researching weight loss "options" for years. I finally came 2 the conclusion last year that I wanted/needed a tool 2 assist me on this journey. The question is about insurance coverage. I have BCN and I was wondering if anyone has had success w/ getting approved through BCN? And if so, can u give me some advice on charting, medically supervised diets, pre-approval processes etc...

Thanks 4 ur time and God bless!

Prin 

BCN has a form that your primary care doctor can print off from Web Denis,  You will need to go in every month - sit down with your doctor discuss your weight, diet, exercise, etc.  You will also need to get weighed every month.  I kept a food journal follow up with my physician on a regular basis and went to weigh****cher.   Unless your BMI is over 50, more than likely they will reject it the first time around.  Make sure that you document everything carefully - when you were weighed, how much you weigned, what "diet plan" you followed - low calorie, low fat, 
south beach, weigh****chers, etc.  If you already have all the documentation, you will want to organize it, give it to your surgeon and PCP.  The surgeon submits all the documentation to BCN.  They can be a pain, but keep at them.  Be patient.  I had to appeal mine once and then they still denied it.  I ended up getting my union involved, suddenly they saw where I had met the critera. 

Delores
 

Thanks for the reply Delores,

? What is Web Denis? Do I, as a patient, have access to that page?
I just started my "6 month medically suprevised diet" last month, so I have 5 months to go b4 I can submit anything. I was thinking about going to Weigh****chers, but I didn't know if that would help me or not? My BMI isn't 50 so I was praying for an approval w/o all the unnessary hassel .
A RNY'er told me 2day that "it can be a hassel to get approval, but if u [I] want them to pay for this $25,000 surgery, than u'd [I] better play by their rules." Let the games begin...

Congrats on ur surgery and I pray that all is going well for you!

Web Denis is the area where providers go to view benefits, eligiblity, claims history, etc for thier patients.  As a insured, you do not have access to that area.  Your doctor's office should know what Web Denis is. 

Weigh****chers is considered a supervised weight loss program.  You need to make sure you go regularly.  Keep all your weigh in's (this proves when you went and what your weight was).  I also keep all of my food journals -  I actually transferred them to an excel spreadsheet.  It made it easier to print off to submit with my appeal.

It can be a hassle - but it is worth it.  The thing about the 6 month diet, is it helps you learn how to eat - what to eat, portion control etc.  I think that has what has helped me the most. 

Delores,
You are so smart! I never thought about how the 6 month thingy could actually benefit me. You are right, if I do what I need to do, then my WLS will be more successful. Good deal...

--Prin

Hello Prin,

I was approved through BCN. It took six months, two written appeals and a face to face appeal.
I was all worth it.  What I am  trying to say is don't give up!  I had a BMI of 48.5 and a lot of commorbities. In the beginning my doctor didn't always document the talks about my weight but, he always weighed me and that helped. I had my surgery two years ago and have lost 153 pounds and have no commorbidites and take no meds.
If you need any other help or advice, please don't hesitate to contact me.


Best of Luck on your journey.

Joni

OMG Joni,

My Dr hasn't been documenting any of our talks about WLS. He was actually the one that suggested WLS to me. How could he not write tha down. UGH!!! I would have completed my 6 month supervised thingy if he had kept better records. I have been weighed every time I went so maybe this will help me too.

Congrats on your terrific weight loss. 153 lbs? Wow that is unbelievable...good deal. Go you!!!

--Prin

Hello,
I have BCN too.  I have a BMI >50 so I did not have to have the 6 month diet history.  I had no difficulty getting approved.  It was a three week wait from the time my paper work was summitted to approval.  Your surgeons office should help you with all the paperwork.  I never did see any of my paperwork.   I would suggest getting a referrel from your PCP to see a bariatric surgeon.   I called  the 1 800 number on my  card and ask BCN to sent me what pre op test and documents they require.  Then stay in touch with your surgeons office to make sure every thing is in order.
Hope this helps and good luck. 
jill

I have BCN as well.  Like Jaellie, I have a >50 BMI, I went for my first visit on 01/29/2009. Then I had to have the H-Pylori test(had a little mix up with my PCP on that one).  Insurance Coord. sent my papers to BCN on 02/19/2009.  i was approved on 03/05/2009.  I just did my pre-op testing and pre-registration yesterday 04/04/2009 and surgery is on Tuesday 04/14/2009.  All of this is for the Sleeve, and I've read how others are having difficulty getting approved for the Sleeve because some ins. co. still look at it as experimental.  Lots of people have told me that mine is one of the fastest approvals that they've ever seen.  One thing, we switched from HAP to BCN last November.  HAP was trying to make us jump through impossible hoops to have surgery.  It was insane and ridiculously expensive what they told me I had to do.  Hope all goes well for you.  Best Wishes.

Thanks for the reply Adrienne,
I see you are going to St. John w/ Dr. Kole. That was one of my first choices as well. Good luck with your upcoming surgery next week. I will keep you in my prayers.

Embrass the forthcoming NEW you!!!