Check online iehp website you can see the minute they make a decision on referral. Yes the surgeon will order everything else. You will go to a seminar then have a consultation, at the consultation they'll talk about your surgery options and give you a list of clearances you must complete mine was an endoscopy, chest xray, galbladder ultrasound, psych eval, ekg, and you need a medical clearance from your pcp separate from the letter of necessity. Depending on your health you might need different clearances but once you finish they'll submit to iehp for surgery and you'll get an answer within 5 business days, I got mine the next business day. The surgeons office knows how to deal with iehp, the biggest hurdle is getting to the surgeon after that it's easy!

I did and I hadn't been in california the last 5 years. Try to get your medical records if you can get 1 weight record per year it will work just know you have to do a pcp assisted weight loss attempt before you can see a surgeon you have to see your pcp or join weigh****chers and go no less than once per calendar month for 6 months

I just had my surgery Tuesday morning, you can get iehp to pay but you have to fight for it.

Hello there!  I'm new to the forum, and wondering if anyone else has the same insurance with me, and therefore, the same issues I might be facing.

I'm hoping to undergo weight loss surgery, specifically the sleeve, sometime this year.  I've been following all the steps laid out by Portsmouth hospital.  In the fall, we hit a small snag with my insurance, and within a day of that appointment, I got a letter in the mail stating changes to the insurance benefits.

So I went on ahead with what I was doing.  Fast forward to now (Jan.), and I was told that another patient with the same insurance as me has been denied.  I looked back over the papers I received.  Based on the the letter I got, all plans were affected (HMO, POS, DPOS, and PPO).  The exclusions on obesity have changed.  The exclusion does not apply to surgical procedures specifically intended to result in weight loss (including bariatric surgery) when the health benefit plan or claims administrator (as applicable)-

   -determines surgery is medically necessary; and

   -surgery is limited to one surgical procedure per lifetime regardless (or even) if: and then it lists the reasons.

The way this is worded, it can be interpreted almost two different ways.  Anyone else deal with Independence Blue Cross recently? And if so, what were your outcomes? 

Thanks for reading :)

I'm curious if you ever got your question answered and if so what were the steps you were given in order for aetna to pay for it. I'm also switching from BCBS to Aetna POS ii. Any advice would be helpful. Thanks! 

BCBS has denied my request for conversion surgery.  It seems they look at it as two surgeries:  band removal, which they won't approve because I don't have any catastrophic problems with it; and WLS, which they won't approve because my BMI is too low!

I was banded in 2007 and lost 100 pounds.  I was very successful at keeping it all off for about 5 years.  Then slowly over about a 1.5 to 2 year period I gained back about 30.  I have always had bad reflux, sliming, PBing, etc.  You all know the story.  Now my doc tells me that my esophagus is stretched and she emptied my band.  Of course I gained another almost 30 pounds in about 3 months.  She's been telling me for a couple of years that I should convert to the sleeve and I finally agreed.  After jumping thru all the hoops required by the insurance company, they denied me.  

Has anybody successfully appealed a BCBS decision?