Question:
Does anyone have helpful tips on how to gain approval thru BC/BS or AZ blue Choice HMO?

   — Kimmer P. (posted on July 23, 2000)

July 23, 2000
Hi Kimmer, I haven't dealt with BC/BS but I can tell you from my own experience with my HMO that your going to need a lot more than a letter from your surgeon. The surgeon has a vested interest in getting the surgery approved, therefore most HMO's need more documentation. I suggest that you gather ALL your weight-loss history, family medical history and write a personal letter explaining what it feels like to be obese and why the surgery is medically necessary. My personal letter was key in getting the approval. Also, if possible have your PCP write a letter. Try to give the most information possible...don't give them the chance to deny your request. Hope this helps. Good luck
   — Fabiola M.

July 24, 2000
Hey Kimmer: I also do not have your HMO, but I was approved relatively easily through Cigna HMO. I started with a PCP who suggested surgery. (That was plain lucky). My PCP wrote a letter defining all of my previous diets (including one physician assisted one) which I told her about. It also included my co-morbidities and family history. She strongly recommended the surgery. I then had to be approved by the med. center to seek more information. That is when I got the referral to the surgeon and had his pre tests done. These were all approved. But the approval for surgery did not come until the surgeon approved me. The whole process took me about 4 months. I think it is unusual to go so fast. The longest wait was getting into the surgeon and scheduling the surgery. I hope this helps. Good luck.
   — Dot W.

July 25, 2000
Is this a BCBSAZ individual plan or is it one provided by your employer? Do you have an evidence of coverage? Are there specific exclusions listed? If you provide this information, I will try to help you go in the right direction? If you wnat, you can e-mail me directly [email protected]
   — MaryAnn K.