Highmark BC/BS

Has anyone been approved with Highmark BCBS and is there anything that I need to know to do so that I won't be denied?  My surgeon's office is making sure that my PCP is writing down the right things in his notes.  I am exercising and trying to eat better.  Please help!!

Hi Samantha! I think the biggest thing I see in my job as the insurance nurse at my bariatric surgeon's is the patients go to the doc each month but the right stuff is not documented. I had one lady insist she had done her supervised diet, but when I got her records, they were monthly followups for a car accident! Just because they weigh you each time does not make it a supervised diet! Each month your doc must put in your notes your vital signs and weight, the type of diet you are following and the type of exercise you are doing. Many docs think that if they write a letter on your behalf, you will get approval, That is not the case, each month needs it. Get a copy of what is required and make sure it is all done. Some have quirky requirements like having a chest x ray. It would be awful to have to fight an appeal over something so stupid! You need the actual list of requirements and you might have to talk to 4 people at your insurer to get it, but it will be worth it! Good luck! Bonnie

Thanks Bonnie!!  The insurance coordinator at my surgeons office had me tell my PCP to fax her his chart notes for the past two months.  SHe found some things that he was writing wrong on there so she had him fix them.  I have to go back tomorrow morning and she wants me to get him to fax her this sheet also to check to make sure that he understood what she was saying.  I just don't want to go through all this and then end up having to do it again.  That would be so devistating for me.  She said that as long as I did what my doctor told me I should be fine.  In about the 5th month she said I need to go to a psycologist and to a nutritionalist because my insurance requires both and my surgeons requires the psycologist visit also.  I am just scared that I am going to mess up and be at the bottom once again.  Thanks for your help though.  It makes me feel better knowing that maybe I am actually doing right.  :0) Samantha

I work at Highmark. I can tell you that there is a medical policy bulletin that you can access on the website. I have been advised to make sure you document everything. I am in my 6 month process right now and am actually worried about being denied as well. But if you read the mpb and follow everything from the dietician to making sure you have all the required testing done you should be fine.