anyone get approved from BC/BS

I keep seeing pricing listed on this site for various different surgeries. I was assuming insurance covered it if it was medically necessary, which it should be for all of us b/c I don't think you'd be considering this surgery if you were skinny and healthy. Anyway, is it hard to get approval from blue cross blue shield?

Hello, I have BCBS Blue Choice. When I went for my appointment the surgeon said "oh, you have blue cross. They will approve (the lap band) quickly". Of course, Brigham and Womens has it all set up to provide the insurance companies with the info they need as quickly and efficiently as possible. They make the nutritionist and shrink appointments for you. When I went to ask my PCP to send a referral, they had already called and gotten it! So the answer to your question is, yes, they cover it but going to a facility that makes it easy to get the approval helps too. Susan

I have BC/BS PPO and I got approved in no time flat for RNY, your best bet seeing as though there are many different levels of coverage is to call BC/BS and find out if you are covered for Weight Loss surgery and what the requirements are. They faxed the info to me in a matter of minutes. Good Luck Gwen

I have BC/BS HMO and was approved in 5 working days. My surgeons' office prepared all the paperwork, faxed it over and voila. You have to 'fit' the BC/BS criteria. Just call member services and they are really helpful.

I have BC/BS Federal. The ONLY requirement that must have been met was if I was at least 100 lbs overweight. I went through Brigham and Womens and they did everything. My paperwork was faxed on a Thursday, and that Monday I called and it was approved. You are best to call BC/BS and ask about your individual policy. They have always been super nice when I have called. Good luck!

I have BCBS HMO Blue New England. My BMI was 40.1 (with no major comordities) and I was approved in fewer than 5 days for a lap RNY...no questions asked. BCBS in MA tends to be one of the more liberal insurers when it comes to WLS from what I understand. Here is most of the patient selection criteria for HMO Blue: Patient Selection Criteria: The physician has indicated that the patient: - is a well informed and motivated patient with acceptable operative risks - a strong desire for substantial weight loss - failure of other non-surgical approaches to long-term weight loss - the patient is enrolled in a program which provides pre-op and post-op multi-disciplinary evaluation and care including: behavioral health, nutrition, and medical management AND the patient is morbidly obese (BMI > 40) OR The patient has a BMI >35 and the physician has indicated that the patient has one or more of the following: - sleep apnea - pickwickian syndrome - pseudotumor cerebri - obesity related cardiomyopathy - type II diabetes - at least stage 1 hypertension - coronary artery disease - obesity related pulmonary hypertension.. Hope this helps some!

Thanks Rockin Red. That's very useful info. It looks like I will get approved then, as long as the doc thinks I'm a suitable candidate for surgery (which I'm doing everything in my power to make sure I am).

I got approved in less than a week for the lap band. I had HMO Blue. I had a $150 hospital copay though. I hope that helps.