Details of BCBS

I am still gathering information, but wanted to hear what some of you had to say. I have called BCBS and they have told me that they do cover the surgery, with the guidelines that my surgeon will be aware of. HOwever no one actually tells you what that is!!! So I am trying to gather experiences with BCBS! I was thinking to write a letter to submit with my information, that would come from me, to explain why I want / need surgery, and if any of you had done that, or if it matters. Since my BMI is 36.5 and I have documented weight loss attempts, and respiratory, refulx, edema, apnea, but havent seen a doc too many times for "all the ailments" I am thinking I will not be approved at first, and maybe not at all, but I want to get into the mindset to know what to expect, to soften the blow! You guys seem to have every scenario covered, and I read the board at least every day. SO I figured you all would know how to first hand pump me up. I meet with Dr. Juarez staff on Nov 14th, and have called places to have my medical records sent to them. Any Info you could give me to send to the insurance, would help! Since I live 2 hours north.. so i also know what to take with me! Thanks so much and God Bless you all!

First think that I would do is call your doctors office and have them tell you what the requirements are. They have the information and should tell you. Then you would at least have some information. The next thing I would do is see my PCP and talk about surgery. Tell him what you want and see if he is going to be supportive. If he is not then get a new PCP. 99% of the insurance require a letter of medically necessary from you PCP and if he is not on your side than the letter will not be very helpfull. I just got approved from Cigna. I had to have 2 documentate weight loss attempt of 26 weeks. I had that and many many other attempts. I also was very straight with my PCP as to wanting surgery. I knew what was wrong with me. Noone gets approved with Cigna the first time so I had my 12 page appeal letter written before I even got my information mailed to Cigna for approval. I guess that what I am trying to say is know your facts, meet the requirements, and be firm and aggressive. This is your life you are fighting for. Good luck, Tanya

GAWD!! All I can say is BE GLAD you don't have CIGNA!!! (it is HELL ON EARTH, and I kid you NOT) If my appeal with an external review board doesn't get approved, I am using my single coverage with BCBS to hopefully get approved. Now, I don't know this for FACT, but I would be willing to bet that they would require the same things as Cigna. BMI of at least 35, with co-morbs, or a BMI of 40+, a Psych eval, a 26 week diet, attendance of a bariatric seminar, up-to-date on your Well Woman exam and letters from your Surgeon and Dr. stating it is medically necessary. GOOD LUCK TO YOU~ Michelle