BCBS again

So when the CSR says that they won't cover it until after the surgery (VSG) if and only if I meet the requirements, how do I know that they will cover?  What happens if the doc thinks insurance will cover it, but they end up denying it? 

I saw your post and saw that you are also stuck in limbo with BCBS.  I am having the VSG surgery at the end of the month and am getting the run around.  Maybe we can help each other.  I was told on the phone it would be covered by one person, then denied when my doctor's office called.  Now I just received an official denial letter.  URRRR....It's frustrating.  I'm searching for help.  If you hear of anything, please let me know and I'll do the same for you.

Good luck to you!

You won't know because you got one of their inept CSR's.  I encountered a few of them myself.  They have to identify if they cover that surgery type but they probably need the official billing code for the VSG.  I know those are posted here on OH somewhere, sorry just can't remember where.  I have BCBS of Illinois, a PPO plan.  My policy covers RNY and lapbands only, all others are considered investigational.  But BCBS has a lot of different variations of their policies.  Plus, check with your employer, if your insurance is thru them.  Sometimes employers have exclusions for WLS.  And lastly, if your insurance plan is listed on their website you can find out the exact criteria for WLS under the Medical Policy for that plan, but again it wouldn't count if your employer excluded it.  That's where I found mine.  I copied it and printed it out to make sure my surgeon's insurance coordinator had the same info (she did).  They make mistakes too because they have to deal with hundreds of plans, all with different qualifying criteria.  I urge you to find out before you have surgery unless you can afford to pay for it yourself.  They have zero interest in your financial burdens, only theirs.  BCBS is notorious for giving out erroneous information over the phone.  Just read past postings and you will learn this too. 

BCBS PA Personal Choice, is not approving VSG so far for me. I'm on round two after being denied. They still always want to call it investigational surgery...what ever you will pay for RNY which is much more expensive and DS which hello, is a two part surgery with VSG being part one...its very frustrating. Hang in there and I sure hope you get approved!