Question:
has anyone heard of bcbs stopping the approval for rny on nov 1,2003

   — kelly M. (posted on October 5, 2003)

October 4, 2003
Yes they are changing their requirements, but I am not sure how it is changing.I have bcbs and my surgery date was scheduled in October because of this.I did not plan on doing it until January . Good Luck !
   — Michigan G.

October 5, 2003
Precisely what have they said. If your policy does not change before your surgery date then the written approval that you have must be honored. It should have indicated in the letter how long the approval is good for. You will need to check with your employer to see if they have implemented a change in the current policy, and if they haven't then BCBS has to honor the policy they signed with your employer. At renewal time though, all bets are off.
   — zoedogcbr

October 5, 2003
I did not hear that BC/BS was stopping approval for wls. What I was told was that they are strengthening their requirements which includes, amongst other things, documentation of 3 years of supervised weight loss attempts. I did hear that their requirments will be changing as of 11-1-03.
   — Kristen S.

October 5, 2003
I have BCBS of IL PPO...I talk to them everyday regarding the status of my request for surgery. The customer service rep told me that lately she has seen letters going out saying that they want the patient on a 12-18 month medically supervised diet before they will consider the surery. Also I have heard that they are flat out denying LapBands.
   — Kara J.

October 5, 2003
BCBS of anwhere has always denied AGB and DS. They only approve a "normal" RNY and a VBG. Their normal RNY is less than 100cm bypassed. They need to get their heads out of the dark ages.
   — zoedogcbr

October 5, 2003
Chris D. thats not true. I'm 6 weeks out tomorrow and had 130cm bypassed. BCBS IL PPO approved me within 10 days I think it was.
   — kathy B.

October 6, 2003
I've heard this and it's had me worried. I'm pre-op and don't have a date yet. I have BCBS of Rhode Island. I called my insurance today and the rep told me that she hasn't heard of anything like that. My suggestion would be to call your insurance company and find out. I know that my surgeon's office has had difficulty in the past with payment with BCBS that has been administered by Anthem (which lucky for me, mine isn't.)They don't want to pay the entire surgeon's fee and they require the surgeon's fee upfront. Hope this helps.
   — Katherine H.

October 6, 2003
Yes I to have heard the rumor that all BCBS of Michigan or Blues as they call themselves were changing over to this new addition to there old requirements of having to provide 3 consecutive years of Supervised Diet Documentation or a combination of Diet Documentation in order to be approved. Well I will only speak of BCBS State of Michigan PPO. I called a few days ago and was told that Blue Care Network of Michigan is the only provider with those requirements. I was told that BCBS State of Michigan PPO will stay as they are and that as of Oct 5, 2003 none of the Blues had any intention of changing requirements by Nov 1, 2003 and as of now not even in Jan of 2004. So those of you in Michigan that have all but, Blue Care Network can be rest assured that no change in insurance requirements are expected at least before Jan 2004. As for the other states im not sure if BCBS is the same from State to State but i'd be calling.
   — De-N-MI