approved?

my surgery is scheduled for the 30th of this month (next wed) and i got a call 2 days ago from the surgeons office saying i was approved (but i was also told that last august, but she messed up and i wasn't really...) today i got a letter from the insurance company (blue cross blue shield of nj) and it says this "we have received a request for review of the planned services indicated above (open bypass). based on the information provided by the treating physicians it has been determined that open gastric bypass is covered under blue cross and blue shield services benefit plan. please note that this letter is not a pre-approval or garuntee of payment. the final payment determination will be based on the hospitals medical documentation for the actual procedure or services performed at the time the claim is submitted....we will base payment of eligible benefits on eligibility at the time of service; payment will also be subject to any benefit limitations and cost sharing applicable at that time" so what does this mean? i'm very very confused. am i approved? or are they just telling me that they got the request?

Hi Nikki, I also have BC/BS. They seem to be having issues with their approval dept. My surgery was on March 6, 2007. In the month leading upto my surgery I was denied for the wrong surgery, approved for the wrong surgery, and finally approved for the right surgery.  The two things that I can suggest is to first call your doctor's office. My doctor's office manager handled the approvals, some doctors have billing staff that handle approvals. These people are used to working with the insurance company's double talk and should be able to let you know what the letter really means. You could also call the insurance company directly. They should be able to tell you what the letter means. I don't have my approval letter infront of me, but I think it had some of that double talk in it. I know that there are many different plans under BC/BS. I know that my plan did cover bypass and lap-band, as long as I did the 6 months of a supervised weight loss plan, the psych eval, and had the BMI and/or co-morbidities. I did/ had all of those hings, so they had to aprove me.  I wish you all the luck in the world, and hope to see you on the loosers side soon. I know insurance is really stressful, but don't let it get to you. 

i am using the insurance coordinator in the doctors office, but i don't know if i trust her. last time around she told me i was approved, and i found out a week prior that only the hospital stay was approved, and they needed a ton more information to process the surgery request so she must have not payed attention to the letter they sent her which is what im afraid she did this time. i also have a different insurance than i did last year do they flat out say "you're approved" or "your pre-approved"? because i thought thats what i was looking for. i forgot to mention, she did call me wednesday and tell me i was approved, but again- out of caution, im afraid it may just be another misunderstanding. i dunno, maybe im just overanalyzing the letter, but i don't want to have it done and it wind up not covered after all

Nikki, Call your insurance companys precertification department.  Ask for your precert number.  If indeed you are approved they issue a precert number,also find out how many days you have been precerted for.  Good luck with your surgery. I also used Dr. Iannace he is a great surgeon. Dorothy

I too have BC/BS. I'm summarizing, but I swear this is what my "approval letter" said: Dear Lisa; According to the information supplied by your physicians, we have determined your gastric bypass medically necessary. Unfortunately, after a large weight loss, some people tend to have excess skin and require plactic surgery to correct it----FORGET IT! We're not paying! Signed, BC/BS of NJ LOL....basically, that's the true brunt of their acceptance letter. This company cracks me up sometimes.  I find with BC/BS, it's always best to call them and get the real scoop. And always get the person's name you spoke with. Lisa

thank you for your replies, i definately planned on calling my insurance company, but since i can't call until tuesday because of the holiday weekend (and how impatient i am haha) i decided to see what you guys thought. i did notice that there is an "inpatient authorization" number in bold at the top, below my name and the procedure description. is that the number you're talking about?

Hi, Everyone. I also have BCBS of NJ through Horizon.  When my dr's office submitted me for "pre-determination", BCBS advised it would take six to eight weeks for this process to be completed.  When the dr's office called last week for an update (at the start of five weeks), the ins company told her to "call back one day before eight weeks is up".  Is that unreal?  She told them "unacceptable" since I, too, have all of the co-morbities and should be a no brainer for approval.  They then told her to call back next week for an update.  My sixth week of waiting begins tomorrow.  The insurance process is the worst part of this!   Good luck.  Cindy

Nikki, Yes, that inpatient authorization number is THE NUMBER. Congratulations Dorothy