insurance BCBS???anyone???

can anyone inlighten me if this is a good insurance for revision approval, i am only a 35 BMI but i am a RnY and want a DS, I have sleep apena, thanks

I have bcbs and my lap band removal and sleeve revision surgery are both approved regardless of jumping through hoops. I am still higher than 35 bmi though but I think it would still be approved even if I wasn't, but I'm not sure if it's because the lap band is so problematic or not. I am currently waiting for my pre-certification so I can have the surgery but they have told me many times over the phone that the procedures will be covered under my plan no questions.

So I'm not sure if this helps you but I would guess your chances are decent?

Part of the dependency is what your employer allows in your benefit plan- they are not all the same.

Oh also, my surgeon told me that if I were to say, have the band removed now and then wait like 6 months to do sleeve that while I would still be approved, I would have to jump through a bunch of hoops all over again like the diet, psych eval, etc. whereas because I need the revision out of medical necessity I won't have to do all that stuff again.   i guess it depends on your surgeon and how they write the letter to the insurance co. If they can write it in a way that lists your problems, comorbidities, and the reasons the first procedure "failed" then your chances are good that you won't have to go through a bunch of stuff first..

thank you, ya the lady on the phone said that i was covered 100% but that she doesnt make the decision, lol, whatever that means

Oh it probably won't be an issue then.  So even though you are "covered" you still have to go through pre-certification (which is what I'm currently waiting for).  My surgeon wrote a long letter to the insurance co stating my medical  necessity for revision and had all the codes in there for everything.  The precertification is just "proof in writing" that the insurance co will for sure pay for it. My stuff was submitted the week before xmas so I am hoping they approve it this week.

I think since you are a revision and still have comorbidities and need to lose more it will hopefully be a non-issue with them.

I have BC/BS and I had a VBG 17 years ago.  I have BP problems, terrible arthritis, and sleep apnea and have gained back every ounce I'd lost then & my BMI is back to about 44.  I'm meeting with the surgeon Tuesday; I've already had the visits with the Nutritionist and Therapist and I've been told "we wouldn't be making these appointments if we weren't sure you're 100% approved."  I haven't had any problems with them.  But I'm obviously much larger than you and have more comorbidities again than you.  I wish you luck.  If your doctor(s) will push for you to be revised, I think the insurance will cooperate.  God bless.

I had bcbs and even after jumping through hoops with psych eval, nutr appt. osteoarth. in hips and both knees, high blood pressure, gerd, depression I was denied , appealed and still denied. But I also realized maybe I was going for the wrong revision ERYN now I have decied on the DS and have new insur.