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BCBS-CA meeting requirements

Deletemyacct

By Deletemyacct, in Insurance & Financing

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Deletemyacct    39

Deletemyacct
Posted

I have BCBS-CA PPO. I had my first appointment yesterday, i have to have 6mths of nutritional visits. I have to show weight history for the past 3 years, I dnt know if I have all 3years. I have a BMI of 43. I will meet the requirements by end of November 2016. What were some of the challenges you experienced with meeting the requirements for the surgery? I am also using the OBand center which i believe is out of network, but they were not concerned. Share your experience getting approved or denied & appeals?

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lolarose13    147

lolarose13
Posted

Hi! We have the same insurance.

This is what my doctor submitted for me to get a lap-band removal and convertion to sleeve:

-6 months diet

- attempted of non-surgical weight lost (gyms, other diets, weight watchers, etc)

- 1 nutritional visit (recent)

- Psychological evaluation (with MPPi test)

- letter of recommendation from surgeon with current weight and height.

- in my case, my BMI was 35, so I needed 1 commorbities (I have several), so I submitted medical records and medication list. If your BMI is higher than 40, you don't need this.

I'm having a lap band removal, so in addition I needed to provide all documentation from lap-band surgery, follow up and complications.

I was approved in 24 hrs and I'm having the surgery in a BCBS Center of Excellence. I had a great experience with the insurance company. After the approval they even called me to see if I had any questions about the surgery. Their customer service is awesome and I'm hoping you will have a great experience with them too!

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Deletemyacct    39

Deletemyacct
Posted

Hi! We have the same insurance.

This is what my doctor submitted for me to get a lap-band removal and convertion to sleeve:

-6 months diet

- attempted of non-surgical weight lost (gyms, other diets, weight watchers, etc)

- 1 nutritional visit (recent)

- Psychological evaluation (with MPPi test)

- letter of recommendation from surgeon with current weight and height.

- in my case, my BMI was 35, so I needed 1 commorbities (I have several), so I submitted medical records and medication list. If your BMI is higher than 40, you don't need this.

I'm having a lap band removal, so in addition I needed to provide all documentation from lap-band surgery, follow up and complications.

I was approved in 24 hrs and I'm having the surgery in a BCBS Center of Excellence. I had a great experience with the insurance company. After the approval they even called me to see if I had any questions about the surgery. Their customer service is awesome and I'm hoping you will have a great experience with them too!

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Awesome! Thank you for sharing, that gives me hope!! I am so excited & looking forward to the next steps:)☺

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Read2016    658

Read2016
Posted

@deuel30... Using an out of network usually means more money out of your pocket, ask about that... They told me any doctor that recorded your weight will work, a Gyn, a primary care etc... Are you getting a lapband?

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Deletemyacct    39

Deletemyacct
Posted

@ so far they said I dnt have to pay anything out of pocket. All appointments are convered all the way to the procedure as everything will be done at the Oband center. I was initially interested in the band but after my first visit I'm really leaning towards the sleeve. I dnt like the idea of the foreign object & the adjustments (I hate needles) & the possibility of having the foreign object for life. I like the sleeve as i have 100lbs to lose & a more permanent solution.

Thank u, I will use my gyn records

Blessings!

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Read2016    658

Read2016
Posted

@deuel130... As a nyer I tend to be a bit skeptical of things, I should keep my mouth shut... I just have to say the Oband centers are on the radio here with an ad every 2 seconds... Anything medical care advertising that much makes me want to run the other way... Having a procedure at a center isn't a good idea, they just don't have the resources in the event there is a complications... This is surgery you want to set yourself up for optimal conditions... A center just can't provide the level of care a hospital can... These Oband centers are very new, what is the doctor's level of experience?...

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Deletemyacct    39

Deletemyacct
Posted

@ I've only had my first appoint. I haven't gotten ask many questions but, this is something I will start inquiring abt next appoint. I plan to also call my insurance & ask questions to get clarification on everything..Thank you!

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kembfly    15

kembfly
Posted (edited)

@ I've only had my first appoint. I haven't gotten ask many questions but, this is something I will start inquiring abt next appoint. I plan to also call my insurance & ask questions to get clarification on everything..Thank you!

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I too have BCBS CA PPO. I was told anything out of network wouldn't be paid. The surgery is covered 100% if I stay in network and they prefer that you use a BSBC center of Excellence. I still have to pay for the specialist appointments and hospital stay. As stated by another member, I'm weary of those type of clinics, especially those that advertise on the radio. They come across as infomercials. Too good to be true! Good luck and please be safe!

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Edited by kembfly

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Deletemyacct    39

Deletemyacct
Posted

@ oh yes, I really appreciate your advice. I really want this but want to start of right & not waste precious time by not being fully informed. I also started googling reviews from patients who used that center. This is a holiday weekend so I will have to wait till Tuesday to contact my insurance.

Thanks again!

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Deletemyacct    39

Deletemyacct
Posted

I called my insurance & spoke to 2 different reps & 2 separate occasions & not much is required. They stated the surgery is covered as long as it's for obesity meeting the bmi requirements. I've set up an appointment to see an in network doctor. If I dnt have to wait 6mths I would be elated

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