State of Florida BCBS
I have decided to have the lap band procedure. Not really sure where to go from here. I dont know if I should see a primary first or what. I dont really have any medical issues except I am too Fat!! :) My bmi is 40- I have state of florida blue cross and blue shield. Does anyone else, have BCBS and been approved so I can follow in your footsteps thru the process. I just need direction from here. I need some insight on good docs also.
First check with your insurance and see if they cover weight loss surgery, and if they cover the lap band. If they do then find a local surgeon, they usually have an information meeting where you can go get your questions answered. Go to that meeting and they should be able to tell you your next step.
Just because two people have BCBS of Florida, it doesn't mean that their journey will be the same, with different programs, you may have an easier time or a harder time than someone else. These insurance company change their requirements almost daily.
Good luck
Just because two people have BCBS of Florida, it doesn't mean that their journey will be the same, with different programs, you may have an easier time or a harder time than someone else. These insurance company change their requirements almost daily.
Good luck
Hi there:
I work for the state of Florida. I have United Health Care. But, I'm familiar with the BCBS program for Lapband. It's basically the same as UHC. With a BMI of 40 you will to have co-morbidities (diabetes, high blood pressure, etc). You will have to go through six months of consecutive nutritional counseling. The best thing you can do is start now on your journey. Go to your General MD and start your nutritional counseling now. Yes, your general MD can do it for you. Call BCBS and ask them what their criteria is for the notes on Nutritional counseling. Then take that information to your general MD and start your session. Mostly they want to see the diet plan you are going to choose for your six months, the type of exercise you are going to do and then the followup every month for six months afterwards. Make sure your MD is explicit on those factors. You will have to have a psychiatric evaluation (yes, they will pay for it). Also ask BCBS what their criteria is for your BMI and what the comorbities are. What agency do you work for? Generally state insurance criteria are the same throughout but you never know. Also, go to an orientation of the surgeons your insurance accepts. You will learn SO much that way. Go to group sessions as well. It's a lot fo work but well worth it. Let me know if I can help further!
I work for the state of Florida. I have United Health Care. But, I'm familiar with the BCBS program for Lapband. It's basically the same as UHC. With a BMI of 40 you will to have co-morbidities (diabetes, high blood pressure, etc). You will have to go through six months of consecutive nutritional counseling. The best thing you can do is start now on your journey. Go to your General MD and start your nutritional counseling now. Yes, your general MD can do it for you. Call BCBS and ask them what their criteria is for the notes on Nutritional counseling. Then take that information to your general MD and start your session. Mostly they want to see the diet plan you are going to choose for your six months, the type of exercise you are going to do and then the followup every month for six months afterwards. Make sure your MD is explicit on those factors. You will have to have a psychiatric evaluation (yes, they will pay for it). Also ask BCBS what their criteria is for your BMI and what the comorbities are. What agency do you work for? Generally state insurance criteria are the same throughout but you never know. Also, go to an orientation of the surgeons your insurance accepts. You will learn SO much that way. Go to group sessions as well. It's a lot fo work but well worth it. Let me know if I can help further!
Oh yeah...My surgeon is Dr. Michel Murr at USF in Tampa. I don't know where you live or how far that is from you. But, he's aweome. Susan in his office can answer all your questions with regard to the surgery, insurance, comorbidities, etc. They have orientations two times a month. The second Thursday and fourth Monday I think. But, check them out!
Ok we have similar plans then. I work for the Dept of Children and Families. :) First check to see what the lowest BMI is that you can have before you need comorbidities to get the insurance to approve it. For example, my BMI is 54.8 so I didn't have to have a comorbidity (which is rare LOL as I'm like you and have NO health issues Thank God!). United Healthcare says if you have a BMI MORE THAN 40 then a comorbidity doesn't have to exist in order to obtain approval. Call BCBS and ask them what the BMI level is without comorbidities. Once you find that out then you know you have a chance for approval or not. You said your BMI is 40 so you're probably okay!! Next ask BCBS if you have to go to a surgeon affiliated with a "CENTER FOR EXCELLENCE" Chances are you will to get BCBS to pay at a premium rate and even if you don't have to go to one per BCBS standards, its a better route as they are more experienced with bariatric patients. Then when you hunt for a surgeon make sure you find one who goes to a Center For Excellence approved hospital. Go to atleast two surgeons orientations. I chose Dr. Rehnke in St. Pete and Dr. Murr in Tampa. I ended up going with Dr. Murr for one reason or another (it's just a personal choice). But I was glad I shopped. Because once I found Dr. Murr, my search was over ;) Both Dr. Rehnke and Dr. Murr are respected MDS and both have "Center for Excellence" standings. I've heard through Dr. Murr's office that he is one of the top ten leading bariatric surgeons in the US. I figured that out when I found he's the COUNCILMAN-AT-LARGE for the ASMBS and the EC Liaison for the Bariatric Medicine Committee of the ASMBS (which is a site all WLS patients should become familiar with ----> www.asbs.org
Definitely get in to see your General. If your general is not "bariatric friendly" your surgeon can recommend a PCP for you (make sure they are in your insurance's plan before making the switch though). Dr. Murr's office offers the nutritional counseling required by your insurance company as well. I think it's $25 per session. I chose my PCP because my PCP is only $15 to see him and I educated him on what my notes needed to say! You will probably have to have a psychiatric evaluation which the insurance company will cover (Dr. Murr's office bundles your psych into your administration fees)...and speaking of those --- You will also have to become very familiar with "administration fees" :( If you have to start saving your pennies, start now. You will PROBABLY need at least $750-$1200 upfront and then you're 10/20/30 percent that you pay on BCBS...whatever your rate is :X
One last thing, with UHC I had to have at least a 1 year history of being overweight. Ask BCBS about that standard as well.
I hope I've helped. Email me anytime. Or message me. My personal email is [email protected]. You can catch me on Yahoo IM under unleashedstorm. It's important to me to educate everyone of the pitfall of insurance journeys. I work in the industry (I'm a Medicaid, FS and Cash Assistance case manager) and I understand how the "system" works :) Take care and good luck!
Definitely get in to see your General. If your general is not "bariatric friendly" your surgeon can recommend a PCP for you (make sure they are in your insurance's plan before making the switch though). Dr. Murr's office offers the nutritional counseling required by your insurance company as well. I think it's $25 per session. I chose my PCP because my PCP is only $15 to see him and I educated him on what my notes needed to say! You will probably have to have a psychiatric evaluation which the insurance company will cover (Dr. Murr's office bundles your psych into your administration fees)...and speaking of those --- You will also have to become very familiar with "administration fees" :( If you have to start saving your pennies, start now. You will PROBABLY need at least $750-$1200 upfront and then you're 10/20/30 percent that you pay on BCBS...whatever your rate is :X
One last thing, with UHC I had to have at least a 1 year history of being overweight. Ask BCBS about that standard as well.
I hope I've helped. Email me anytime. Or message me. My personal email is [email protected]. You can catch me on Yahoo IM under unleashedstorm. It's important to me to educate everyone of the pitfall of insurance journeys. I work in the industry (I'm a Medicaid, FS and Cash Assistance case manager) and I understand how the "system" works :) Take care and good luck!
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