Blue Cross/Blue Shield TN

My insurance just changed effective May 1 from Blue Cross/Blue Shield (private subsidy) to BC/BS TN. I haven't received all of my medical information yet, but I've seen where several people with this coverage have been covered for various WL surgeries. I'm looking to connect with someone who has this coverage who might be able to give me some pointers just in case I run into some road blocks along the way. I want to speed the approval of my LapBand surgery as fast as possible.........any help out there? Susan :help: Memphis, TN Dr. George Woodman (hopeful surgeon) WTD: 240 lbs.

You need to check the details of your plan. Each BCBS plan is different based on what the employer chooses. I am the benefits coordinator at work and we just changed to BCBS of TN as of May 1st too. Our plan has a written exclusion for ANY medical &/or surgical treatment for the treatment of morbid obesity, even if medically necessary. I had been hoping they would include WLS in our new plan because I've had a few employees ask about it (even before I had my surgery). I'm on my husband's insurance so mine was covered. He has BCBS of MN through his employer. But, like I said, every BCBS plan is different. Good luck Susan. I'll be praying that everything goes your way and you get a quick approval. Susan - too!

Susan, You'll have to check your benefits information. Like was said by the previous poster..each employer is different. Just call the customer service number on the back of your card when you receive it. Good luck April

Speaking of BCBS of TN... I have that particular insurance, although WLS is not excluded. Every "flavor" is different. At any rate, effective May 1st, the insurance I have requires you drop 10% of your overall excess weight and keep it off for six months before they'll consider approval. I found this out while I was in the surgeon's office Friday. My question is, if I could drop the weight WITHOUT help, why in the world would I even come to the insurance company looking for WLS?!? So many folks out there think this is just the easy way out. I don't think they have any idea how not true that is. Mercy. Surgery is Tuesday. Wish me luck! Marianne

I am having some issues as well. Our employer is self funded. They pay BCBS to handle their claims. So, our employer has started a program of 3 months weight loss/education/exercise to help those who want surgery. There are several answers I am unable to get. Come to find out, BC has attached all of their criteria to the approval process, and those graduating out of the Dec 2005 program have not had or been approved for WLS! We were all led to believe that after the 3 month program, we could then have surgery. Wrong! We were told we have to lose 10% of our body weight. My question was: I meet the criteria of being 100 pounds overweight and having a 43 BMI when I entered the program. If I lose 10% of my body weight, I will have a 38.9 BMI. So, will BC deny me because I don't have comorbidities? No one seems to know. Another question: we are told that the diagnosis of obesity has to been given to us for 5 yrs. And, 2 yrs worth of weight loss attempts. What specifically are they looking for? I was put on the Atkins Diet in 2001 from a chiropractor, weighed in each doctor's visit, asked my physicians from time to time about diets, pills, etc. But as far as having the doctor prescribe medicine OR go to weigh****chers... I didn't do that. But I have been on the Atkins & South Beach off and on since 2001. Lose, gain, lose gain. What are they looking for? I also found out that if we fail the 3 month program, we have to pay BC back $1500 to $1800! Well what if I just deny them like they will deny me? haha Not really but you know what I mean. If our employer has set this program up, BC is making everyone jump through hoops, but I was told that no one who went through the program has been completely denied. They just take a long time to get approved. So I wonder if I write letters and appeal it with HR Dept. Will that work? Suggestions? I know what insurance companies do and their little tactics.... I am getting gunned up and ready because I know it will be a fight. Today I wrote all my doctor's offices and requested records to be sent to my surgeon before the program even starts, that way it can all get approved BEFORE I get out of the 3 month program... or at least give me a jump start.

Hi Susan, I also have BCBS of TN and it has been a MAJOR hassle. On April 13th they changed their requirements for WLS. The first thing I would do though is to call them and discuss it with them. They should be able to tell you whether your employer covers WLS and then they can point you to their website (www.bcbst.com) that shows everything that has to be done. Of course you can go to the website yourself and type in bariatric surgery in the search field and then link into their new bariatric decision support tool. If your employer covers the surgery there are a lot of things that you will need to do in order to get it all put together including discussions with your PCP, documentation of all types of weight loss attempts (diet, exercise, medications, etc.), and then the psychological evaluation which now consists of the Minnesota Multiphasic Personality Inventory (MMPI 2); and IQ screening; and The Eating Disorder Inventory (EDI-2) or the Eating Attitudes Test (EAT-26) PLUS an interview and documentation of the participants willingness to comply with both the pre and postoperative treatment plans. So long and short - if it is covered you need to see your PCP, have him/her fill in or cover all of what they ask for, also do a letter of recommendation - then have all of the psych evals. You may want to see if your network has a bariatric coordinator that can help you through the process. When I finally made the decision to go this route I found that there is a bariatric coordinator and we had a HUGE series of tests and other things that I had to do as well. I first spoke with my PCP about this surger and got the ball rolling back in January (mid to late) and I am now on the last hurdle which is insurance approval. But all of this just makes me more commited than ever. Good luck to you and please keep us posted.

I have BCBS of Tn I ahd lapband in December I had no problem getting approved and they were very kind and helpful Good Luck, Tammy

I work for the State of Tennessee and had BC/BS of TN (POS****il 1/1/06 when they switched providers. It took me a year of "fighting" to get approved. I went through the 6 months MD supervised wt. loss...went to Weigh****chers weekly and then weighed in once a month at the MD's office. I was told by BC/BS that as long as I weighed in monthly, it would be accepted. At any rate, I didn't try too hard even though I had the co-morbidities to back it up. Just wanted to keep my bases covered. When everything was completed, I was denied for the 3rd time because my Nurse Practitioner had been signing off on my papers and "they" wanted my MD to sign off too. That's all it took and I was approved 4 days later. I suggest that you keep a notebook and everytime you talk to BC/BS, write down who you talked to, their ID/ reference number, the date and time--just in case they try to deny they talked to you. I also keep notes on every MD visit so I don't forget what I was told. Also, be sure to check your policy and keep a copy of the specific part of it that discusses LapBand/ Bypass. Good Luck and let me know if I can help!!! KarenT

Well, I have found out that I will have to complete the "Bariatric Surgery Decision Tool" with my surgeon, have my PCP submit at least 5 years worth of records documenting obesity and any conversations we have had about it, & go through a psychological evaluation before they will even consider my case. I have just found out that my insurance will be changing ~yet again~ in a month to Humana. So, I am not even going to begin the process until I can find out what hoops I'm going to have to jump through for them. Thanks for all of y'all's advice...it really has given me some things to look at in my process. I'm not giving up, though. I have two precious angels depending on me being here for a long time and I'm going to do everything in my power to not let them down. Good luck everyone!!! I'll post when I find out about my new insurance. Susan Memphis, TN Dr. George Woodman (hopeful surgeon) WTD: 240 lbs. H: 5' 5"