WORRIED! Please answer if you have BCBS

Hi AGAIN... Ok.. I just got off the phone with BCBS. and the lady said the surgery may or may not be paid for unless certain medical guidelines are met.. YES I understand this... But what I asked before is what was your BMI when you was approved and I got those answers.. IF my BMI is 52... Do you think I would have a problem with BCBS approving me.. The only issues I have with my weight is aching joints and asthma(not bad asthma but i do have inhalers).. No diabetes or anything like that.. I was 303 yesterday and this morning I was 298.. because I took water pills and really have only eaten 2 Dannon light and fit yogurts(this is bad I know) but I'm scared to death that they are going to say you need to lose 20-40 before we can approve.. Also is it a doctor preference on your BMI.. I mean if he wants it to be 40 or something to do the surgery...or would I have to have the RNY? of course I have the option to lose 20 and re-try I guess I just  need a few answers..STRESSING myself out here... and one more thing.. I'm reading how some of the ladies on OH say the total cost they had to pay out of pocket was anywhere from 2500-5000.. and I was wondering WHY? BCBS told me that if the doctor I'm going to is a H.M.O. and inside my network that the surgery would be 100% paid for.. I know I don't pay for my Nut exam.. it's covered.. Already got the answer from the people at Chrysalis Center.. (WELL I have to pay $120 for that) My nutrionist was $200 and the co-pays for my doctor visits are 20 or 30.. so what exactly are some people paying for when they spend the 2500-5000? if you had to pay this I would love to know what it was on.. I have a few thousands saved but wasn't planning on having to pay that much.. Even if I had to pay that much it's still better than paying the whole thing out right from my own pocket.. Just curious.. thanks all

I have BCBS federal and it is to my understanding that if your BMI is over 40 youwill be elligible. You also need weight record from Dr. for 5 years....visite to nutritionist....Psy. evaluation .......Upper GI....and bloodtest.....physical etc......But your Dr. should give you a to do list when you meet with him.  Be prepared to wait. My visit with the Dr. was June 8 and I am still waiting for him to sign off on my chart. Each Dr. is a little different but I think those are a rough list of INs. requirements. Your BMI should be OK Good Luck Myrtis

Me  again.....I was refering to RNY wls. If you are considering Lap Band I don't know. Mine also pays 100 on Nut. visits...... up to 5 a year. But my Nut will not turn it in ...I have to.  My BCBS Fed pays 90% if it is in program.  I will prob. have to pay 2000 but that is my co -pay.If you have a HMO you may have better coverage than I. Don't be afraid to call your ins. co. I did    Also differrent Dr.s have  diff. ideas about BMI. I have heard that some do not like to operate on people with a BMI over 60. Do you have a DR.?  If so he may have a clinic web site for some of this info. Hope I helped a little Myrtis

you could just go to bcbsnc.com and actually read your policy. it will tell you what the guidelines are. in general BCBS requires a BMI of 40+ w/o co-morbidities. but all BCBS policies are not alike. people who have paid some money for their surgery might have had 80/20 coverage or something different. you don't have to stress about this if you have a source for your specific questions about your specific policy -- ask BCBS. listen to what they tell you. they know what your coverage is. they know what's covered. 

I can't speak as to what BCBS requires, you'll have to check with your insurance policy for that.  I'm wondering however if the ones you're reading about that are 2500-5000 out of pocket are different insurance than you.  I am in that ballpark but I've got MedCost and they're only 80/20.  Also, RNY costs more than LapBand and that will contribute to higher out of pocket expenses.  Even among BCBS members there is a disparity in coverage depending on what type of policy your employer has chosen.  The best thing you can do is read over your policy and talk to your doctor's insurance representative when you meet with them.  They'll be familiar with your policy and be able to tell you what you want to know, most likely.  Take care. Ellen

Thank you so much... I did talk to someone at BC.. and she said they can't really say until my doctor has submitted in all my paperwork..  So far I will meet with him on the 14th, and I'm going to my doctor's office and get all my records that FINALLY came in.. all i need now is my NUT exam and my blood work and ekg and chest x-ray which is scheduled for aug. 16th and 23rd and 29th. Once these things are done.. I can have my 2nd appointment with Dr. Harris.. the group meeting is next Monday I believe.. and then it's the waiting process for me.... thank you so much for your responses and God bless

Hi there!  I have BCBS of NC PPO. With my insurance, I have a $1,000.00 deductible and 80/20 coverage up to a $1,000.00 co-insurance on hospital stays/procedures. My deductible was met by most of my pre-op appointments.   My surgeon required us to pay the remaining co-insurance before surgery.    Every plan is different, but BCBS WILL go over your benefits with you prior being approved for surgery.  If you are going to a Center of Excellence or a BCBS Center of Exellence, you should have no problems being approved. Take care, Candice

HIjack...How can you find out if a place is a Center of Excellence or a BCBS Center of Excellence?

go to BCBSNC.com

Hi,      Where are you located? Cape Fear is a center of excellence. They are in Fayetteville. I have BCBS PPO (state employees). I had to pay 2200.00 out of pocket. Previously I had paid almost 700.00 out of pocket for my testing. Unfortunately I had my testing on last years fiscal year and my surgery after the new fiscal year had begun. The good thing about that is whatever I do through June 30, 2008 is paid for.....lol. This is no cheap surgery. I figure actual costs with testing have to be about 30,000+++. Good luck with things. I had my approval in one week, by the way. BMI of 46 and no comorbidities. I had to have 5 documented years of weight(not consecutive) and doctor's referral and of course all the pre-op testing. Good luck. Lisa