Generic Surgery Process Questions

Can anyone help me find out the process to getting approval from my health insurance company. They just recently said that they will pay for gastric bypass surgery but I am not sure how to even start the process. I have been reading various tid bits about the surgery for the last year or so. I really want to know about the cost of the whole process when you have Regence medical insurance and what all has to be done to be approved. Any help would be greatly appreciated. Thanks

My surgeon in Coos Bay took care of everything. I went in for a consultation, decided the surgery was for me and he took everything from there. He did all the work to get the approval. I did nada. Was very few requirements - go to a support group at least once, see a psychologist, take some blood tests, and go to a WLS class. Six weeks later I was informed I was approved by Blue Cross and the rest is history. It couldn't have been easier for me. The best part is that Blue Cross covered everything but $100.

I would call customer service at Regence and ask to speak to a representative that can tell you the specific requirements that your policy requires to be approved for gastric bypass. Usually they have some canned specifications that start with "must be dertermined that the procedure is medically necessary". They should be able to tell you the specifics of your coverage. Ask what their exclusions are. Some ask for documentation of at least six months of weight loss, a letter of referral from your physician, psychological evaluation, sleep study, etc. Depending on what those are start to get the ball rolling on which ever ones you can. It was great when I saw my surgeon that some of the things were already done. My insurance covered my surgery 100 percent, so I didn't really get specifics about the actual costs. How much you are covered will determine how interested you will be in the dollar amount. It can seem like a remote and far off thing. One foot in front of the other. It is great that you are beginning to research it. Keep coming back here and ask about things - someone is bound to have encountered something similiar. Patty

If it's state of Oregon Regence, there is only 1 surgery center they will let you have it at, and that is somewhere in the Portland area I believe. First call Regence and find out what you need to do. Likely they will want a doctor's referral. You should also get started documenting your weight loss attempts and any supervised medical diets you've been on. Document everything because it will be required. BC/BS should be able to give you the low-down on how to get going on this. Good luck! Dina

Hi Beka If you are a state employee and have Regence Blue Cross, you have to use Legacy Hospital in Portland. When I talked to an insurance rep two weeks ago, she stated that the doctors are slowly coming on board and they do anticipate more hospitals being covered. She didn't have anything else to tell me. I do know that only the RNY is approved for insurance billing and you have to go through 6 months of hoops before they will approve you for surgery. Nancy