BLUE CROSS BLUE SHEILD qUESTIONS ( BLUE CARE)

HI EVERYONE, Good evenging all....I just wanted to get on and ask a few questions to anyone out there who has bc/bs.... i just upgraded my health ins. to bc/bs (blue care) and i just found out that they cover gastric bypass. my question to ANYONE out the ...is do they require you to have been on a diet, 6 months of monthly weigh in's with your pcp, how many year of medical documentation. I hope that someone can give me some information. because I'm going to file to insurance for my surgery Jan 1/2007 . Please help or send me a email [email protected] Stephanie

Hi Stephanie, I have Blue Cross Blue Shield (blue Care) National plan. and they denied me for not having 6 month documented diet but I did have last year diet documented not to mention lots of medical history of all my comorbidies. They kept asking me for more information and I gave them everything I had. after they denied me I sent in an appeal and 3 weeks went by with out a word from them so my sugeons office did an appeal and I finally got an approval on Dec 22. I have a surgery date for Jan 16!! Just keep on them and give them everything and anything you can, they will try like crazy not to pay for the surgery. I almost gave up because they gave me such a hard time but I figured if they denied me again I would have to start weigh****chers for 6 month to give them that, but Im so glad I didnt have to do that and now Im approved. Good Luck and remember Never Give Up!! Denise

BCBSNC approved my surgery the same day the request was submitted. I don't know much about other Blue Cross plans, but if you have BCBSNC and go to a surgeon on their "Centers of Excellence" list, it's pretty easy. I went for my 1st visit in August and my surgery is scheduled for Feburary 8, 2007. If you go to BCBSNC.com you can see the medical policy for WLS, it's pretty straightforward. You have to provide a 5 year weight history, and your surgeon's office takes care of pretty much everything else.

I agree with the previous poster. I don't know about the blue care program, I have BCBSNC PPO (and BCBS Federal as secondary) and the surgeon's office was a Center of Exellence and they got approval for me over the phone, before they even sent in my paper work. I had not been on a Dr supervised diet. I did have proof of my weight for the last 5 years (from my OB-GYN appts), but that was it. My only comorbidity was sleep apnea. Good Luck, hope you are easily approved.

it amazes me to read these type of posts,,,,,,read my profile, and you will see that BCBS is NOT jumping to cover ANY surgeries! Steve

I have BCBS Blue Options PPO... they required 5 years of weight history from me and that was it.... I know they were supposidly making some changes in August to their requirements/approval process so it may have changed since then. They should be able to send you in writing what the requirements are

I have Blue Cross Blue Shield PPO and I am in the preauthorization process. Prayerfully, things will work out for the good when my information is submitted to the insurance company. I have some information from their website and I have spoken to several ppl and the process seems relatively straight forward. My policy stated that I needed 5 years of weight history and I am having that information sent to the surgeon's office. It may be helpful if the people in your surgeon's office file the insurance information for you. Good luck and hopefully we will BOTH be on the losing side in 2007!

I am double insured and they had to submit to my primary before they could get it to BCBS Blue Options which is my secondary. They submitted paperwork to the primary and then to the secondary and I was approved for surgery 21 days later. I had 6 months of a medically monitored diet and exercise program plus my weight history for the past 5 years. My primary doesn't cover the surgery so I had to wait for them to go through them first. It would have been quicker if I had just had BCBS. I was told usually they have a response within 48 hrs. Amanda Stone-Secrest

It depends on who you have BCBS with. And your Employers policys plan. I just got Empire BCBS of New York and they cover the surgery but the website says that I need to check my Employers Bennefit plan which I'm still waiting on. Someone resently told me that you company may want to keep the price down and exclude WLS. I sure hope not. I wasn't sure about the 6 month weight loss so I went ahead and started seeing a nutritionist and your only required to loose maybe 2-3 lbs weight per month per Susan. I've gone 3 times so far and I've still lost 6 lbs. 1 the first month, 5 the second. I didn't want to lose to much until I know whats happening. Good luck and let me know if I can help you search anything. CathyS

I just found out that my BCBS will cover my surgery 100%. All I will have to pay is $150.00 for my deductable. Now I have to hope that my co-morbid are enough to qualify me. CathyS