Just Starting

I am just starting on this journey. I currently have Companion and from what I understand, they do not cover the surgery. I am able to switch insurance in October which would take effect in January. I called the Dr. office and they suggested Companion - MUSC options. However, I was looking through some paperwork and there seems to be a limitations - exclusions part in there about the surgery? Does anyone have any additional info on that? I am also in the process of changing Primary Care physicians. I am wondering, which Dr. does the main letter to the insurance company for approval of the surgery? My Primary or the Surgeon? Does the Primary just need to refer me to the surgeon and then they take it from there? I am sooo confused. Any help anyone could give would be very much appreciated.

My insurances has an exclusion policy against WLS unless medically necesssary that's why you have to have a letter from the surgeon and your PCP. The PCP is a support letter in favor of the surgery and usually tells all your co-morbidities. The surgeon writes the main letter about the surgery, your height, weight, and BMI. You need both letters plus all the other stuff, like psychological clearance. It can be a tedious journey, but don't give up. This site is wonderful and gives you so much info for example I just used a sample letter I found on this site, made the necessary changes, and took it to my PCP for her to sign. I'm at the process where I have completed all my pre-clearances and just waiting for my packet to go to BCBS for approval. I'm hoping for a surgery day in late june or early july.

Thanks for your information and encouragement. I would love a copy of the letter you said you got from here. I could use all the help I can get.

Im just starting too, and I have Companion HMO. I heard that they had made some adjustments with BCBS this year and it pays if it is proved to be for medical reasons. Companion is a part of BCBS so I am hoping they are starting to cover the surgery. I have talked with my PCP and he is going to refer me to a surgeon and hopefully I will find out there if it is covered. Good luck to you.. E-mail me any time.