BCBS of Nebraska

Hello everyone,  

I live in California but I have BCBS of Nebraska  Does anyone know the requirements needed to have them approve you for gastric bypass?  I called ins. and they weren't very helpful, stated Dr has to get authorization.  Dr states I have to document my diet for 6 months before they can get authorization.  I was hoping this has changed.  

Thanks,
Valerie

Hi Val,

 Is WLS a covered benefit under your plan?  If you are unsure I would suggest that you call BCBS back and ask them for a copy of the policy, you probably received it when you first signed up for benefits.  The policy will tell you if WLS is or is not a covered benefit.  Also BCBS of MN has a website that you can log into once you sign up,  here is the their site www.bluecrossmn.com.  Once logged into their site you can query wls policy and it will come up with their protocols that you as a patient have to meet. Good luck on your wls journey

Hi Valerie,  With our BCBS of NE, we did not have to do to much however, it was because it was a covered benefit from my wife's employer.  I would suggest checking with your HR department and specifically with someone who is very knowledgeable on the benefits that they offer to employees.

Thanks for the info....it is very encouraging.  I didn't want to have to go thru the 6 month PCP dietician visits.  I did contact benefits (HR dept isn't very helpful) and they did state is was covered.  I know the Dr.'s office is going to put in for authorization.  I have my fingers crossed.  Thanks again.

My BCBS of NE covered it as long as I had a BMI of at least 40 (or 35 + at least 1 comorbility), had been overweight for at least 5 years, be at least 16 or older, and didn't have a documented reason why I couldn't lose weight.  I didn't have to do a diet thankfully.  You should call BCBS of NE and ask "Is there an exclusion on my policy for the surgical treatment of morbid obesity?"  If there is an exclusion you will have to self pay.  If there isn't an exclusion, then you will have to do whatever else our policy lists as a qualification.  When I originally asked BCBS stated that treatment is NOT covered EXCEPT for covered surgical procedures.  I asked what the covered surgical procedures were Roux en Y Gastric bypass, Gastric stapling, Biliopancreatic diversion with duodenal switch, Laparoscopic or open gastric banding (e.g., Lap-Band) and Loop gastric bypass.  Of couse your policy could be different.