BCBS PPO

Does anyone know what kind of revision bcbs ppo covers? I know they are one of the better insurances out there. They originally covered my lap band 5 years ago, which is now "broken". Don't know if it matters, but I live in Michigan.

 I have Blue Cross PPO/EPO of Alabama. The same policy covered my Mini Gastric Bypass ten years ago. I'm now seeking a revision to Rny for medical complications. My surgeon's office submitted for insurance approval on August 20th. I got a letter a week or so ago asking the surgeon for a copy of the upper endoscopy pictures. No approval yet, but my surgeon's office keeps telling me that they don't expect to have any problems getting approval because I have more than three years of documented complications. We'll see.

There is a list of requirements with Blue Cross that tell what you need to do to get approved for revision if you are seeking revision for weight-loss. If you have a mechanical failure with your band or other health problems that cause you to need a revision, it's supposed to be pretty quick and easy to get approval, so I hear. Good luck!

 I have BCBS of MI and they would not give me prior approval.  The only requirements they told me is that it had to be medically necessary and could not be simply because I did not make it to goal after my first WLS and as long as I met this there would not be a problem.  I fought for pre approval but they would not budge.

My surgery was about a year ago.  They paid the surgeon, the anesthesiologist, the the pre testing but denied the claim for the facilities charge in the tune of $16,000.00!  Of course I am fighting with them over this....Doesn't make sense why they would pay for absolutely everything else and then deny the facility charge.   Looks like I will be going into appeal.  Long story short, get the prior approval then you would not have these worries...

Good Luck to you.

 Wow...Thanks a million for the heads up! That's awful that they would stick you with the bill for that. I would never even had considered anything like that happening. They have been paying all of my pre-op testing. I don't think my surgeon would even operate without making sure everything was paid up-front. Even if he would, the hospital would most likely want their share up-front, too. Still, I'm glad I know to watch for this if they refuse to pre-authorize.

The letter said that they could not make a predetermination without further information, requesting upper endoscopy pictures. The insurance girl at my surgeon's office sent an email saying not to worry, that they were only requesting additional information. I'm hoping to hear something this week since it's been a month. We'll see. Thanks for the information.

I have BCBS Horizon Direct Access PPO and they cover everything except the "experimental" stuff - they won't cover Stomaphyx or Rose. They will cover the DS, RNY, etc. The only bad thing is that they are making me redo the whole 6 month diet evaluation before going, as if things are going to change. It's a delay tactic, nothing more.

I am going for the revision because I need to get rid of the VBG that was added to my RNY. It causes reflux and it's bothering the heck out of me. Knowing I have esophageal erosion, you think they'd approve it right away. Pfft. It's not like it's stomach acid coming up - no way it could with the RNY.

Anyway, I shouldn't complain too much, but just make sure to look up everything. They should have their bariatric requirements online.