BC/BS PEBB Approved and Scheduled

I wanted to pass on the good news that BC/BS PEBB has approved my surgery (RNY at Legacy Obesity Institute in April). I understand that I am the first state employee with BC/BS in Oregon to be approved. It wasn't easy but they did accept my 6 mos of WL attempt with my PCP. They also accepted my documented 5% WL from the PCP. They asked the NP at the Obesity Institute to write a letter stating that the Obesity Institute would recognize my PCP's records for WL attempt and 5% loss. Once she submitted this letter, it was approved. I hope this gives hope to others who are in process with BC/BS. Good luck.

Renee, CONGRATULATIONS! I'm so happy for you ... and happy to hear that Regence approved you! I also have Regence (PEBB) and I've almost lost my 5%. Then they will submit my information to Regence and wait for approval. May I ask how long it took for Regence to approve you once Legacy submitted your paperwork? When is your surgery date? Deanna

Deanna - BCBS took 5 days to request more information then it took almost two weeks to get the additional information from Legacy to BCBS. It may have taken longer since I was the first so there were lots of questions about exactly what BCBS wanted. After the additional information was submitted, they approved me in two days. I was very proactive about calling Legacy and BCBS often - friendly but persistant! I am now gearing up for surgery on 4/3. Good luck to you as you finish your pre-op. Renee

Renee, Thanks for your help! That gives me a better idea of what to expect. Wow, your surgery is really soon! I imagine you are scared but excited! Keep us posted about how the surgery goes and how you're doing! Deanna

I hate to be silly but what is PEBB? Is it Public Employee's ?? I have Regence BC BS through the public school boards assosciation and was denied coverage as this group did not carry the rider. It is my secondary insurance and my primary has just approved me but would be nice to have the secondary pick up the 20%. But doubt that it will do that before I have my surgery. I had anticipated self pay so having one of my insurances pay is good. Julia

Hi Renee, Congrats on your approval. That must feel wonderful. When are you having your surgery in April? I bet your are excited. All the best. Patti

Hi Wendy! Sorry to butt in ... but I know you and I e-mailed each other once last fall. I remember your pretty picture! Glad to hear you're still in the game! I also have BCBS (Pebb) ... I started in February with my first appointments and by last week I had lost my 5% so they were submitting my information for approval from BCBS. Anyway, there is no longer a 6 month wait; it's up to the discretion of the surgeon. However, the 5% weightloss is still required. I'm biting my nails just waiting to hear from Legacy! I'm so anxious!!! Deanna