Insurance approval process for Gastric Sleeve (Blue Cross Blue Shield)

Im from illinois but have bcbs of south carolina. I hope i don't have to do the 6 months of dieting.

I'm in Western NewYork. Only three months medically supervised diet is required.

When you receive the letter from BC/BS saying that you are approved and that the doctor and hospital will be paid at in-network rates save the letter.  I had a file that I kept everything related to the surgery in and boy am I glad I did.  I was quite floored a couple of weeks ago to receive a check for just over $1,000 telling me that was what they were paying toward the surgery and that I was responsible for the rest since my doctor was out of network.  I got right on the phone with them and they were nice, but essentially were saying they would 'take another look at things' once I faxed them over the letter and they 'verified it was the actual letter they sent me'.  My doctor's office is now billing me in addition to fighting with BC/BS.  I have an advocate program at my job and I will probably call them today to see how they can intervene.  Even if I end up having to pay my doctor out of pocket it will still have been worth it, but I am hopeful that between the doctor's office, the employee advocate and going to state agencies if I have to, that based on the per-certification letter I have in my possession they will have to make good on this.  My point is not to scare you but to encourage you to save every bit of communication you receive from BC/BS and all documents you're given by the professionals you see during the process in case you need 'evidence' later.

I had bcbs of Illinois. .. it took me a total of a about 30 days  ... I saw the surgeon in march my sleeve was done on 4/8 ... In that time I jumped though hoops some days 2 dr visits a day ...  my pcp wrote the note...As far as the psych evaluation it was quick for me ... they just wanted to make sure my head was in the right place for the surgery and that I was doing it for the right reasons. ... my bcbs had no 6 month waiting at all.... they are all different! !! Best of luck to you !!! :-)

♡ Kelly

HEY I WILL BE SWITCHING TO BLUECROSS I WAS WONDERING WHICH PLAN DO YOU HAVE, PPO OR HMO,.

This is my hope!!!! And prayer! Because I've gone back-and-forth with the decision and changes with jobs, I'm truly hoping to not have to go to the six months of waiting.

I have BCBS of Iowa Alliance Select and was JUST APPROVED for my gastric bypass surgery!! I was in the middle of my 6mo dr supervised diet and exercise plan when BCBS changed their requirements and as of August  9th, I believe, they no longer require the dr supervised diet. I was submitted and got approval in 24hrs. Psych eval wasn't bad at all. Good luck to you :)

 

I have blue cross blue shield of Illinois (silver plan) and it went extremely smoothly. The only thing they wanted was a nutritional consultation. Of course the doctor wanted more than that. I had to have the usually psych, sleep test, blood test, and consultation. Plus a EGD. It took a month and a half to get approved and I have my surgery next weds.

I also have BC/BS and am halfway through the pre-process. I have attended a seminar, 1 appointment with the surgeon, 1 with nutritionist, and had 1 with the NP today, whom I will see from here on out. Psych eval is scheduled in December. My WW diet, however, is not moving. I haven't lost a pound in all three months, which concerns me! I need to do something else so it shows I'm making an effort. Ugh.

I have a plan through Highmark BCBS. I was initially denied but my doctor's office appealed and my surgery went through as scheduled. It was hair raising because they denied me ONE WEEK before I was scheduled for surgery (six weeks after it was submitted to them). 

The six months of medical weight management had to be consecutive, and I had missed a month or two along the way, even though I wound up with 8 visits. They also had to be with the same provider, so we couldn't use visits I'd done with my PCP. 

Anyway, my surgeon and his administrative assistant went above and beyond to get me the surgery. BCBS was going to pay one way or the other, it was just a matter of July or January.