BCBS of TN

I just attended my second seminar for treatment of weight loss.  This time I went to a different hospital not that there is nothing wrong with the first hospital just changed my mind on where I would like to go.  I am jsut starting the paperwork and appointment scheduling and my question is has anybody used the BCBS of TN insurance to have their surgery approved, and if you have may I ask the time length it took and did you run into any roadblocks?  Thank you for your help David

David,          I am not a BCBS patient, but I have heard others state that they require that you lose 10% of your excess body weight before being approved for surgery.  Which program are you with, because each one has someone that they prefer you to go to for mental exam and some have other requirements as well, if you say who you are with then someone from that program can possibly help you with the steps and their experience. Congrats!! Shelia

Hi David, I have BC/BS of TN. if you look at your insurance card they have their web address on it. You can register and set up a pass word and then monitor your review progress. The web page will also list the requirements needed to get approved. It will also tell you if your policy allows the surgery and what they will cover. BC/BS told me once they receive your paperwork it takes them 2-3 days to scan it in then its sent to a review officer who can take up to 30 days to make a decision. Hope this helps. Bob 

Hey Spanky I am still trying to get mine approved with the same wonderful metro bc/bs.....I am using Dr Westmoreland in Murfreesboro and they are really good to work with.....ours requires a 6month supervised (by MD) diet, meetings with a nutritionist, and lose 10% of your beginning weight (at the start of the 6 months)......I haven't been able to lose the 10% but with letters from my endocrinologist and PCP they believe that they can still get it approved.........I'll send you private message on here with my phone number and explain it all if you want........what hospitals are you looking at? and which surgery?  Hang in there buddy.......give me a call WENDY

Every BCBS of TN policy is different depending on the employer. If you haven't already, call the customer service number on your card and ask for the specifics for your plan. Be aware that not all BCBS of TN plans cover WLS, it depends on your employer. Make sure they look up your specific plan and ask them exactly what the requirements are for coverage. That way you can get a jump on pulling together anything you can provide to the clinic and have it ready the first time you go in. I had my old Weigh****cher membership books from 2001-2003 to show my supervised diet attempts. I have BCBS of MN and it took less than 2 weeks for my approval. My paperwork was submitted on December 19th and I was approved January 3rd. I figured that was pretty good considering the 2 holidays during that time period. Most BCBS plans do require a 10% weight loss and/or 6 months supervised diet before they will approve.

Hi David,    I don't want to discourage you but I have been trying 18 months to get approved. I have BCBS of TN PPO. They are horrible. I had to have a psy. evaluation with several more things from the psy. I also had to loose 10% of my weight. Had to have documents from doctors to prove I have been over weight for 5 yrs. You can pull it up the requirements on their web site. I can e-mail them to you if you want. The reason I am having trouble is because I don't have any medical problems. I do have arthritics in one knee & heel spurs. It quotes if you are 100 lbs. over or bmi is over 40 you do not have to have medical problems. I am 150 over & bmi is 47 or 48. So, I should qualify. I have really got tired of messing with them. My surgeons office was no help, so I was on my own. One thing I did wrong was I had all the tests my surgeon reqested. I would reccommend to EVERYONE not to do all that until your approved. My detuctible was 2,500 so I paid all that for nothing. Anyway I wish you good luck. I may change doctors & start over with someone that fights for us. By the way, I was going to Memphis. Oh, the last thing I was turned down for was the question that I lost the 10%. I lost it fast in 3 months by doing the liquid protein diet & starving. The letter from my pcp was sent in Dec. 2006 saying I had lost it & how I did. Dec. 2007 they sent a letter questioning it. Of course a yr. later I had ever lb. back. So, I just threw my hands up. Ellen

Ellen, you have to lose the 10% prior to surgery, if you gained it back, crash diet again and lose it. Atkins works well for this, get it documented by your PCP, beginning weight, end weight and program you did. If that was the only reason you were denied this time, lose the weight then submit the documentation, you will win. Bonnie Knoxville, TN

I am a nurse for a bariatric surgeon in knoxville, and do this all day, so let me clairify for you... If you have bcbs of tn and are NOT on the state employee's bcbs of tn (and your policy covers wls), here are your rules: 5 year wt history comprehensive psych eval lose 10% of your initial body weight rules are available on the www.bcbst.com site, at the very top it states it does not apply to bluecare (medicaid) or the STATE employees contracts....most is exactly the same......here is where they differ..... state employees need to do the 6 month diet and FAIL at losing the 10% got that? best of luck--the hoops are worth it...believe me.... bonnie rny 6/3/05 264/155

Hi, Bonnie,    This is Ellen the post before yours. Can you read my post & tell me what you think my problem is? What do you think I need to do? As I said I am BCBS TN PPO. The surgeons office I was using don't help with appeals. Thankas Ellen

Bonnie, Who were you going to in Memphis, if I may ask?  Can't recall if we communicated before or not, but I have BC/BS of TN  Federal Employee Plan.  I had to have 6 months of medically supervised weight management history, medically I have high blood pressure under control with a small level of medication, depression medications, bmi of +50.  My approval took place 2.5 weeks.   I didn't have to loose 10% of my weight, or attempt to, but I have lost 9 lbs and 7" since I started drinking protein shake for breakfast 8 weeks ago.   I think I said this on this list before, but have any of you having problems with the insurance approval, called the Insurance Commissioner in Nashville, TN.    May be worth your time.   Sharon/Memphis