BCBSM after surgery approval??

I have BCBSM PPO and my Dr's office said they don'y give approvals. You just have to wait till after surgery and submit. They say I should be covered but I'm freaking out a little becuase I only have a BMI of 38.8, joint pain, incontinence, & low blood sugar. None of the huge things they are asking for.

Anybody similar to this or have another experience, I'd love to hear so maybe I can calm down a little.

Thanks for the help :o)
Tanya

 I have BCBS of MS and mine is the same thing.  They wouldn't do pre-approvals.  Here's the thing....even a pre-approval doesn't guarantee that insurance will pay for your surgery.  My surgeon's office was leery about doing the surgery without it, but they went ahead and went through with it.  It's only been 2 weeks since my surgery, but I don't regret it.  The claim is being put in now so we'll find out of insurance will live up to expectations and actually pay it....we'll see.  If not, I'll fight it.  But make sure you meet ALL of their medical policy criteria for having weight loss surgery so they don't have anything they can come back on to say why they wouldn't cover your surgery.  Work with your surgeon's office on this and then DO IT!  It's one of the best things I've ever done and it's been a fantastic event so far. 

Best of luck!

Thanks for your post. If you don't mind me asking, what was your BMI and co's to start? I think I'm going to love doing this too but am just freaking out a little about have to pay for it if it's not covered.  Drs office says they've never not had it paid for, so that promising. Gook luck with everything and thanks again

Tanya

Which surgery are you going to have?  I had the VSG done.  I had bmi of 37 and I had, diabetes type II, high blood pressure, sleep apenea, high cholesterol.

I live on Oklahoma and I have BCBS Federal Employee Program.  I did self pay, cause my doctor said that BCBC and is not in network.  He said that some of his patients that have BCBS Federal would submit a claim after the surgery and they did get reimbursed on some of the money they paid about 4K more or less.  The surgery was 12,500.00.  When my doctor turned in the claim for me after the surgery, they used cpt code of 43659,  BCBS denied that claim because of the code.  I found out that other VSGers with BCBS Fed used cpt code 43843  and were approved.  My doctor turned in a corrected claim with the cpt code of 43843  So, that's were I am right now waiting for BCBS Federal to make their decision on my claim.  I hope to get approved.  If not, you better believe that I will appeal this.

Be sure to find out the cpt code of your surgery and check it out with your insurance.    I hope you get your surgery and get reimbursed from it. 

blessing
babygirlinokc

Thanks for the post, I'm haveing RNY, I don't think VSG is cover here, just band, rny, or ds over bmi 50. (from what I've read) 

I really hope yours is approved, good luck with everything
Tanya

Yes, you are right. 

Hope everything runs smoothly with you too.