Blue Cross Blue Shield of Minnesota

Hey Everyone,  I just had a question that I wanted to see if anyone had insight on. I am in the process of getting WLS surgery. In January, I am switching to BCBS of Minnesota and was wondering what anyone's experiences were with this insurance? I currently have BCBS of Alabama and from what I have heard they aren't that great to work with. So far this is what I have done:  1. psych evaluation 2. completed 6 month medically supervised diet This is what I am working on:  1. have an appt with dietician on January 10th 2. Have last medically supervised diet doctor appt January 2nd Is there anything else anyone can think of that I need to do for BCBS of MN?  Thanks for your help! Rose

Hi Rose!! First congratulations on your decision to have WLS. I have BCBS of MN and the only thing I would say you are missing is the Psych eval. May just be one or 2 appts with a shrink you may need??? I had to take the MMPI psych test and visit with him 2 times.  Make sure you ask the Dr office, they should know what you still need to do!!!  Good Luck and welcome!!  CarolN

Oh, did I not mention that I did have the psych evaulation. I am going through United Hospital and they kind of got me started on that processs. I am glad I did it though, because I wasn't going to at first because BCBS of AL doesn't require it, but I did it anyway so now that I am changing, it all worked out.

Hey neighbor!   Im in SSP... so happy to meet you!  Your pictures are soooo pretty. I have your insurance and I think what Carol said it right.   I had no problems with them and was approved in two weeks.

How about coming to the coffee group Monday night at the caribou across from applebees and six? You could meet some board people and ask bunches of questions! If you ever want to get together one on one just let me know since Im so close....Id be more than happy to help! Hugs and welcome... Linda

Thanks! I am glad to here that BCBS is pretty good about it. From what I can tell my current insurance sucks as far as getting approved.

Aww I would love to come to coffee, but I can't tonight because I have a dentist appt. I would love to get together though another time, how often do you meet?

Thanks for making yourself available to help, that means a lot.  Rose

hi Rose: my experience with BCBS of MN has been good but,  KEEP DOING YOUR MEDICALLY SUPERVISED DIET! the last info I saw showed my plan switching to requiring a 12 month diet and only 2 years of proof of MO. at the time I got aproved the diet was 3 months. that is a change, I THINK it is in effect, since you are halfway done, please keep it up. a nurse from BCBS actually calls me at home every other month or so to see if I am taking my vitamins, etc. I think they are really interested in the aftercare.

good luck!

 

judi

Hi Rose & welcome! I will be having BCBS - MN also in January and not sure how their plan reads right now, but my PCP told me last week she believes you have to do 6-months doctor supervised diet before they approve you. She said BCBS changes that requirement all the time it seems, so just to keep working with the surgeon's office, they deal with this day in & day out. Best wishes on your journey!

Hey There! I have BCBS of MN and you've gotten all sorts of good info from everyone!  I also wanted to add that I have to show three years of weight history.  I got my medical records from my pcp and that is suppossed to be the best proof of MO.  Just an FYI! Good luck...and keep us updated! Jeanne

I can't answer you BCBS questions...just popping in to say welcome and congratulate you on choosing WLS!!  You won't be sorry!! Hugs, connie d   

Hi Rose Welcome to the boards! I have BCBS MN and I am in the process also. Many people at my work have had WLS and they have BCBS and none have ever had a problem being approved after following the criteria. Depending on where you are going your doctors/nurses may have a list of things you need to do. Other that that I will post below what it says in the BCBS MN medical policy. It is what the people at BC i have talked to told me that they go by. I have asked about 100x (LoL) and they tell me as long as all these are met you will be approved. Good Luck to you!!

The surgical treatment of morbid obesity is ACCEPTED MEDICAL PRACTICE for patients who meet the following criteria: 1. The patient must have a Body Mass Index (BMI) of ³40. Patients with a BMI of 35-40 will be considered when there is documentation of a co-morbid condition, such as hypertension refractory to standard drug regimens, cardiovascular disease, degenerative joint disease, documented obstructive sleep apnea, severe persistent asthma, or diabetes (See attached Body Mass Index [BMI] table at the end of this policy. This table was adapted from the NIH "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults"). 2. The condition of morbid obesity must be of at least two years duration. Because attempts to lose weight over this two-year time period may cause the patient’s BMI to fluctuate around the required levels, the two-year time period will not necessarily start over, or be prolonged, but will be reviewed on a case-by-case basis. 3. The patient has participated in at least one medically-supervised attempt to lose weight within the past two years. The medically supervised weight loss attempt(s) must have been at least six (6) months in duration and must be under the direction of a medical doctor (MD or DO), physician’s assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS) or a registered dietitian supervised by an MD, DO, PA, NP, or CNS. The patient’s participation in a structured weight loss program must be documented in the medical record by an attending physician who supervised the patient’s progress. A physician’s notation, alone, is not sufficient documentation. Documentation should include medical records of the patient’s progress throughout the course of the weight loss program. 4. The patient must be evaluated preoperatively by an eligible licensed mental health provider (i.e., licensed psychologist [Ph.D or M.A], licensed clinical social worker [LICSW], or licensed marriage and family therapist [LMFT]) to ensure the patient’s ability to understand, tolerate and comply with all phases of care and to ensure a commitment to long-term follow-up requirements. The evaluation must also ensure that any psychiatric, chemical dependency, or eating disorder contraindications to the surgery have been ruled out. Documentation of this evaluation must be included in the prior authorization. 5. The physician requesting authorization for the surgery must confirm that the the patient’s treatment plan includes pre- and post-operative dietary evaluations*