BCBS Question

Who out there had BCBS insurance for their surgery? How difficult was it to get approved? Do they have a cap on how much they will pay for the surgery? How long did you have to wait for approval? I am asking for a friend. She is so nervous about dealing with her insurance I am just trying to find some answers for her. I have tried looking through the insurance section, but for the most part people don't answer these specific questions. Jen 345/307/180

PS this is Horizon BCBS PPO policy

You should have your friend contact the toll free number on her insurance card and ask all of the questions she may have. They will be her best source for factual answers. Good Luck

I didn't have any issues. I just had to prove it was medically necessary. I just provided all the standard stuff, proof of diet attempts, pysch eval, mo + comorbities. Although I do understand that not all BCBS policies are the same. I was approved within a couple days of receiving all the documents. good luck! bob

I have BCBS PPO, I had no trouble getting approved. Have her call the number on the back they can tell her about a cap, deductables everything she needs to know. She should call them anyway because some BCBS policy's don't cover the surgery. It depends on you policy and your coverage through the employeer. If she has contacted them alreay they should have told her abou the other stuff. She needs to call them first before getting into this. I have a $100 co pay for in patient no cap and was approved with in 3 weeks of applying for it. But she needs to contact them before she moves on with it,. Rynae

Sweetshe - she planned on calling her insurance but I knew they would be anything but honest about how difficult the process is and how long it takes to get approved. I know with my own insurance I got a completely different answer each time and NONE of them were right. Sure enough...when she did call, they were elusive about approval time and about if there was a cap. How in the heck can you be elusive about a cap??? You either have one or you don't. She was told that 'it all depends on her approval'...whatever that means. Bob - Thanks so much for your helpful answer! I am sure she will be encouraged to know that not all ins companies drag their feet when it comes to approval! Rynae - She was told they cover the surgery 'if it is deemed medically necessary' I believe that her bmi is about 45, but she doesn't have any serious co-morbidities, although she does have some milder ones like cronic abdominal hernias, vericose veins and fibromialgia (sp?). I think she is concerned that the ins co will tell her its not medically necessary. She has done every diet plan known to man and then some and will probably be able to document most of it, so that shouldn't be an issue. Thanks for your help though, three weeks is an excellent turnaround on the approval process, hopefully her's will be quick as well.

I have Anthem BCBS Traditional Plan...there are so many BCBS plans. She needs to check her policy, if she does not have one, contact her employer's main office and request one. This has all the information of what they cover and what they do not. Also, you must be firm with the insurance company...mine did not want to pay, after I had approval and after I already had the surgery...but, I insisted on what my plan did cover (I had my policy right in front of me), and eventually the lady on the phone agreed that I was right!! So, do not be timid with them. Be nice...just not timid!!!!!!!!!!!!!!!!!!!!!! Keep all copies of everything the insurance company sends you...before and after surgery!! Hope this helps a little!! Jeannie