Question:
what are the requirments for bc/bs?

i have been trying on and off for the bypass surgeryfor 4 yrs. now, I have also changed insurance (aetna who denied me due to the 5yr consecutive obesity becaus in 03' I was on a crash diet and fell right under the line). I havebeen marriedand on my husbands bc/bs for 5 months,his mother had the surgery through them in 2005 with very little trouble and I have many more health problems then she did.Any advice on dealing with the insurance devils?CristinaV    — luvbug0218 (posted on January 14, 2007)

January 14, 2007
my advice is to let your surgeon's office handle it. if he has a good staff they will know how to get you approved quickly or at the very least what requirements have to be met for which surgeries and whether or not the exclusions can be appealed or how to get around them. aetna does deny on first try as most do. additional medical diagnosis' are also required when trying to obtain approval.
   — _blue_

January 14, 2007
I concur. Your doctor should have a relationship with BCBS and should know how to get you approved. As long as BCBS covers wls and you have co-morbidities or a 40 BMI you should not have a problem getting covered. In my case, I have Horizon BCBS (NJ) and my doctor got me approved after the psych and nutrition evaluation! I did not have any out of pocket expenses (deductibles) because my doctor and the hospital accepted what BCBS paid. If your doctor doesn't want to get you approved, look for a different doctor.
   — Sheri A.

January 15, 2007
I have BC/BS of Iowa - Alliance Select. The requirements in my policy are: *40+ BMI for 3 years or 35+ w/comorbidity or 50+ *3 yrs medically supervised diet or 3 yrs medical supervision of comorbidity(s) *Psych eval But that's just my policy, most policies have slight differences and some employers opt not to include WLS in the plan. The HR department of your husband's company should be able to give you a copy of the policy.
   — jactkb

January 15, 2007
I had Horizon bc/bs of NJ and they approved my surgery right away. I had what I thought were NO comorbidities, but my surgeon's office came up with all kinds of things. Let them submit the paperwork......they know what to say.
   — barefootgirl

January 16, 2007
I had no problems with BC/BS approving me for my first surgery (lapband 10/05) but did have problems with amerihealth for a revision to RNY in august 06. i found my doctors office to be to busy and aggitated when I would ask my status, so i started bugging the insurance company myself. the more i called, at least once a week, the higher person i got to deal with until I got to the top. It worked for me, i am one month post op now and have lost over 20 lbs already. sometimes it is worth being a pain in the b--- if it gets you what you want. i dont usually act like this but it sure worked for me. best of luck to you, you really should not have a problem with BC/BS.
   — noboat4u

January 16, 2007
I have not had my surgery done yet but I have BC/BS Federal and so far have not had any problems. I have a BMI of 35 and looking at Lapbanding. The staff at my doctors office handles everything with the insurance. They know exactly what to do and how to submit the paperwork for your approval. I was approved within 2 weeks. Good Luck...
   — Karen M.