BCBS Of NEPA

I Know that it has probably been asked but I am just starting my WLS adventure and cannot figure out my Insurance website that is supposed to be Newcomer friendly...needless to say I left it very confused.  I did email the Support person in regards to the requirements.  I have set up my seminar and Fast track with Dr Kwon but I am OCD about looking things up.  This is the first time I have even considered WLS with my insurance company.  Any help would be great.  

I can't address your personal coverage of course but I had a very long journey with my insurance company (it was HIghmark BC at the time)  prior to approval. I'd recommend that you call - talk to a real person. Ask specifically for the list of requirements for approval. Write the list down and get the persona's name. In my case, they kept pulling new requirements out of the hat but of course never telling me where things stood. And bear in mind that every case is different, so your requirements may include something a bit unique based on results of initial screenings. 

 

Good luck!

Lynn, gave you excellent advice. . . and when I considered the WLS option, I first called my insurance provider to see if they covered WLS and what hoops of their's I'd have to jump through. . .

Best wishes as you pursue your goal towards healthier and a more engaged way of living

I did get into contact with my sister hospital that does the surgery, they said that it is covered as long as I meet the requirements of 1 nutritionist visit, 1 pysch visit, BMI over 35. I also need a letter from my PC. So in 10 to 12 weeks I will be on the table! Thanks for your help!

 

I also have BC/BS NEPA PPO and found the customer support person on the 800 number very helpful in getting me information I needed to make my WLS decision.  My employer (hospital) has a WLS center, so we had to use them (surgeons there are GREAT!) but any other tests I needed for the approval process were no stress and fully covered.  I was approved the 1st time I was presented to the insurance, but also had 2 co-morbidities.  When you question them, give the name of your surgery center, the doctor's name and also the names of those on his support team.  You don't want to be surprised by a bill from the dietician or psychologist which your insurance will not cover.  Most centers have the team support members also covered under the plan which they accept but there can be exceptions.  

Best wishes to you and being informed about the surgery you want and its costs is a good step in being an informed patient!

That was my insurance and they were great at the time. BC of NEPA aka First Priority Health. Keep in mind every plan is different and if it is through work employers tend to customize their plan options.

At the time of my surgery if I went to a "Center of Excellence" the process was streamlined.

As long as I stay in network and do everything that the insurance requires which was 1.  Join a gym and get fitness verification, 2. EKG, 3. Ultrasound of the gallbladder, 4. Nut and Psych, 5.PCP letter of support and Endoscopy.  I have everything done and my next appt is the 16th  my first appt was 9/4  so hopefully I will have a surgery date in November.  I am so glad my insurance didn't require the Dr to do a supervised diet for 6 months.    Thanks so much for every ones help.  Funny how the only thing I am worried about is the Insurance.