Question:
Who or how do you get approval(I have BC/BS of Fla)state employee

In other words,I am switching healthcare providers during open enrollment in October,Bc/Bs told me to get started with my PcP doing the 6 month thing (Dr.assisted diet program) now, which I did in August, they said that way, I'd already have that behind me when my Insurance kicks in Jan.2008...what I need to know is..how do I go about getting approved? Does my PcP do it...or my Insurance? How does the whole process work?? I really need help with this...what is an approval letter?? i'd really apprieciate answers...I'm really green when It comes to all this..oh,I want the RNY by the way.    — NoLeChiC (posted on September 17, 2007)

September 17, 2007
First of all make sure that BCBS does not have any provision written in the policy. You shoukd be able to obtain that info from them over the phone. I have BCBS of TX and they covered my procedure. But my PCP did all of my paper work for me. I actually had to get a referral to my surgeon from my PCP and my surgeons office submitted all of the necessary paperwork. Everything for me went really fast. I was able to schedule my sleep study, psyc. visit, ultrasounds, and etc. all within a two week period. I did not have to do the 6 month thing though. The approval letter all of that was done through my surgeon's office. It took me 1 1/2 month to get approved for surgery. I am now 11 months out after have the RNY. I am down 92 pounds. I went from a size 20 to a size 8. So good luck and if you have any further questions email me.
   — The One

September 17, 2007
The staff at the program you choose should do all the work for you. They will send in the letter for med necessity and all the documentattion from your PCP for the 6 month medically supervised weight loss and all else needed to get you approved, at least in the program I am in thats what we do, we schedule all the pro op and get that all authorized and so on. Make sure you pick a program and a surgeon that will meet your needs, you should not have to do a thing. Cindy Carbaugh
   — carcar01

September 18, 2007
With most insurances your PCP has to file a form to pre-authorize you seeing a WLS surgeon. You usually can find the form on your insurance company's website, make sure you include "pre-authorization" or "authorize" in the title with gastricbypass. On the form is usually states what they are looking at for approval. Many insurances will approve surgery if they have approved the consult with the surgeon. Best of luck-Heather
   — tazthewiz23

September 18, 2007
I have BCBS Federal (in Florida) and the staff at my surgeon's office did everything. Check your plan to find out the exact requirements. My plan did not require a 6 month doctor assisted diet program. The surgeon's office submitted the necessary paperwork to BCBS and I had my approval in about two weeks. GOOD LUCK !!
   — AngelaC.

September 18, 2007
I have BCBS Fed in NC. No 6 mo thing required. I gathered all I needed from my pcp and/or gyn office. Needed documentation that I had been at this weight for 5 yrs. Made my own appt with the surgeon. They did all the rest. Was approved within 10 days of my final visit at the surgeon (after nutrition counseling, psych counseling, pulmonary function testing, and venous ultrasound). My surgeon's office has an information seminar once a month which all patients are required to attend before their first appt to find out about different insurance requirements and required documentation to bring to the first appt. BCBS paid all but $100 of the hospital bill. 11 months out and 90lbs down From size 18/20 to 8.
   — debramc