Can anyone share their approval experiences with BCBS of AZ?

Hello,

We are new to this and are thrilled to have found this website.  DH and I would both like to have the bypass surgery done, starting with him.  Our group health insurance is changing to a Blue Cross Blue Shield Preferred PPO plan that has a 1k bariatric access fee and $1500 deductible.  How hard is it to get approved through BCBS?  Is it typically about 6 months?

We have done a little bit of research about which doctors to use, and are looking for information seminars to attend wtihin the next 1-3 weeks.  If DH does indeed face a 6 month waiting period, he needs to get started now so as to schedule the surgery by the end of this year.  We would really love it if someone could share their experiences with BCBS.  Many thanks!

BCBS paid for my Prox Rny over 7 years ago.  And, they just paid for my revision to a DS (should have had a DS in the first place!) 2 weeks ago.

I'm not sure what their requirements are now but my understanding is that if Medicare covers a procedure then the rest of the insurances follow suit and cover it as well.....UNLESS you have an employer based exclusion.  Have you checked your policy?  If you know people at your employment who have had it done then chances are very likely that it's not a problem.

As far as approval time?  AFTER you fill all of your insurance checklist AND the hospital program's checklist....then they will submit to your insurance.  At tht point, most people know within 2 weeks or less.

As far as my opinion on programs in the area:

If you're positive you want an Rny, then I would say that Dr. Fang and Dr. Juarez are your best bets at Phoenix St Luke's.  Their comprehensive program is amazing!

If you want to go with one of the latest greatest options, (the sleeve) then I would highly recommend Dr. Podkamini at Banner Gateway.  Their entire program is most likely the best in all of AZ!

If you go with the surgery that the majority consider the best, the Duodenal Switch, also known as a DS....then you may want to wait until Dr. Husted comes to Phoenix in June.  Unfortunately he is going to be joining a program and a clinic that are known to have a poor quality program and the surgery will be done at one of the nastiest hospitals in the valley (had surgery there!)

If you are interested in just information regarding the DS then I'd suggest that both you and your hubby join us for a Super Weight Loss surgery Seminar which is sponsored by a peer support group on June 5th.  Dr. Keshishian will be speaking and talking one on one with people.  He's one of he leading DS surgeon's in the world.

Please check out the Duodenal Switch forum as well as www.dsfacts.com  It's worth checking into if you're not only wanting to lose weight but be able to keep it off as well.  It is statistically the superior WLS in the world.

I'm excited for you and your hubby.  My hubby and I did ours 9 months from each other and have loved getting healthy together.  We found new recreational likes, hobbies, etc.  Our kids have all left home now but they got to have us for a while as active/healthy parents.  Now we're able to play with the grand kiddos and love life!

Best wishes!

PS if you want details on seminar.....just scroll down the Recent Posts and you'll get times and addresses.

Thank you for your response!  For reasons I won't get in to here, we are really hoping to use Banner Good Samaritan as the hospital of choice (probably equal in importance than the doctor performing the surgery). 

We are in a more remote part of AZ and will be traveling 3-4 hours each way to see a doctor in the Phoenix area.  We will be in the Phx area the weekend of June 5 but have plans that will keep us busy until around 5 p.m.

Surgery makes me nervous!  But I am most happy for my husband, and I think that in supporting him, my weight will probably come off quickly as well.  He has at least 100 pounds to lose to be at a healthier weight, I have closer to 75-85 pounds.  With our kids to consider, we need to make sure he is 100% recovered and healthy before I start the journey.  Really hoping he does not have to wait 6 months or go through the medically supervised diet, but we are waiting for a copy of our policy certificate from BCBS, so I am not sure what the plan docs will state about bariatric surgery requirements (other than 1k access fee). 

Anyhow, thanks again!  

Did Banner Good Sam start a Bariatrics program again?  I know they shut it down a year ago or so but I suspect they remain equipped for Bariatrics?  Hmmmm....let us know and good luck!....Oh and I'd recommend continuing research on the TYPE of surgery.  The surgeon CAN make a HUGE difference as some have much better stats than others and some even have some "pings" against them.  Be your advocate for your body and your hubby's bodies.  Your kiddos definitely need a healthy mom and dad.

www.dsfacts.com

I had my surgery 2 weeks ago and my insurance is BCBS of AZ. I had to 1000$ fee but my deductible is 3500$. They did require a 6 month diet, but I had been in TOPS for a year and they took that as my 6 month diet.  I am keeping careful track of the money I am spending and when I reach my 3500$ I will stop paying everyone and then talk with the insurance company if there are any problems. So far they have been very helpful.  The other thing they required was proof that had been obese for 5 years. I was missing a year in there (I did not go to the doctor for a year so there was no record of my weight at all for a full year). However, BCBS still approved my surgery. I had no co-morbidities, but my BMI was 49 and they approved me.  Oh, once the doctor's office submitted my paperwork, I was approved the next day, so they were pretty quick for me.

My surgery was at Banner Gateway in Gilbert. I had a fantastic experience with them and with my doctor. I highly recommend them too. The hospital required 400$ when I checkout but I have a feeling they would have accepted less. My doctor's office allows me to make payments.

Good luck on your journey! While you are waiting for your 6 month diet, you can go through many of the other pre-surgery requirements such as a psych eval and other tests so it won't be like you are spinning your wheels, waiting.