OOPS--Insurance SNAFU! State Employees Beware

My most recent lab work for follow up from RNY was denied by State Employees Health Plan because they don't cover weight loss.  If you have to have follow up visits for one year after WLS your provider must apply for prior approval the day that you leave the hospital or you are not covered.  I don't know how my other lab visits managed to slip through but this one was flatly denied.  I called Customer Service and they explained that anything related to WLS post op must have prior approval.  If you are like me and caught after the fact, a retroactive approval letter can be written by your doctor.   If you have NC State Employees Health Plan/BCBS  you must get prior approval for anything tied to your weight loss surgery both before and after the fact.   Hope this helps with any future surprises we might get from BCBS. 

I haven't had any problems yet.  I just emailed the nurse in our program and alerted him so he can check it out.  Thanks for the heads up!  Alice

Wow that is good to know...I haven't heard of that yet. I knew band fills needed pre-cert but I haven't heard of anything else needing it. Thanks for the heads up!

Ruby, here is what Paul at ECU had to say:

I have not heard that but it certainly would not surprise me.  I know that we have had issues if the practice bills using the Obesity, Morbid – 278.01 instead of Nonabsorption, Intestine Postsurgical – 579.3.

Thanks for the information!   Amanda

This truely stinks. I am new to BCBS NC State Employee's but I had my RNY under United Health Plan.  The whole BCBS program stinks in my opinion.  I wonder what else they are going to deny next.  They just want to get out paying. I hope things work out for you.

So, they won't pay for the follow-up blood work but they paid for the surgery???  I have this plan...I wonder if they just submit it as an annual physical if they would pay then???

So do we call and have all post op appointments approved prior to the visit? I'm confused...

I suggest that you talk to the insurance dept at your respective practice and make sure they are filling it right.  See the note above where Paul from ECU replied to my question to him....  none of my labs have been denied.