BC/BS AZ - PPO

Hello everyone. I am completely new to the wls thing and this site. I will attend the seminar at SBC on September 10th and I have an appointment with Dr. Emmershad on 9/13. I have been researching wls for 3 years and have finally decided I am ready to do this. My question is about insurance. Does anyone have any experience with approval, criteria, problems with BC/BS AZ - PPO? If so, please e-mail me. Thanks.

Congrats Peggy !!!! I had united healthcare and no problems - I would suggest calling to find out what the criteria for approval is with the insurance company - they will tell you right over the phone. I had surgery with Dr Blackstone 6 weeks ago - and very happy. Sbc is a little more money out ofpocket - But well worth it . I researched the surgery for almost 5 yrs before I got to have it . Good Luck and keep us posted !!

From what I understand Blue Cross Blue Shield of AZ (most BCBS are now) is very difficult to get approved with. But you will receive more information once you meet with the financial coordinator's at SBC. I have BCBS of New York, so it wasn't as difficult. But from what I understand BCBS of AZ will not cover lap band. And anything has to be medical necessity and patient needs to have co-morbities. You can go to the insurance section of the site, click on AZ and review all the insurances that have been approved for BCBS of AZ and each person's process. Good Luck to you... I might see you at the seminar, I might be going with a friend of mine from work for support!

Hi there Peggy! From my understanding, BCBS of AZ is quite difficult. I know one of the requirements is a diet history of 12 consecutive months. BCBS of AZ is a mirror image of BCBS of MN for the Gastric Bypass approval. My hubby has BCBS of MN and I have BCBS of NC. You can look up the requirements on the BCBS website and get the exact information or wait until you talk with the Financial/Insurance Advisor at your surgeons office... I wish you the best of luck! Tiff

Hi Peggy, what they require is 6 months of a supervised weight loss program, (I did Weigh****cher's) and 3 times a week attendance at an exercise facility that is documented. My experience and to others I've talked to who has them all had two denials, approved on the second appeal. I think though if you have all of your paperwork in order, you should be fine.

Hello!! Thanks so much for the info. Which exercise facility did you use? I have an appointment with Dr. Emmershad at SBC on the 13th of September which will work for the supervised weight loss program. I wasn't sure if I should go through her or go to WW or both because I will probably only check in with the Dr. once a month and I believe BC/BS requires a weekly status report. Do you know if WW counts as weekly nutritional counseling? Enough about me. Have you gotten a surgery date yet? I hope it is soon and I wish you the very best. I have really enjoyed reading everyone's various experiences as well as the long-term goals people are making and maintaining. My PCP was very knowledgeable, supportive and informative about having the procedure done. It helps with the comfort level of this whole thing. Again, thank you for responding. It really helps hearing someone else's experience. Have a great day!!

Hi Peggy, I don't have BC BS insurance. But I wanted to say best of luck to you on getting it approved. I went through Dr. Emershad for a three month pre-op diet. She is great and really focuses on how you will be eating after surgery. Protein first and chewing your food really well. I lost 31 pounds on the pre-op diet and 70 since surgery. So as of today I have lost 101 pounds. Best of luck to you on your journey. Melissa

Peggy, I have AZ BCBS HMO and my revision was approved in less than 24 hours - but the only criteria needed for revision was 1 of 20 documented mechanical failures. I would advise calling insurance and asking that written criteria be sent to you - the number you'll be given is a recording - ask for criteria forWLS. They're pretty good about getting it out right away - it's nine pages. Or if you want to give me your address or fax # - I'll send it to you. Best of luck! Debbie