Insurance Approval

[cocojohn 0]

First , Sorry if this as been asked. I couldn't find any answers regarding this.

My insurance company (BCBS of IA) states that Bariatric Surgery is not a covered procedure. It reads "Bariatric and morbid obesity-related surgery, including but not limited to panniculectomy or other body contouring procedures, is excluded". But, she did say something about Physician sending in MR for approval.

Has anyone had this answer, but was still approved for their surgery? What criteria is needed to be approved? I have registered for a seminar with a surgery team, not until the end of April. But a bit nervous, and don't want to waste time if the surgery won't be approved at the end. Also how long does it generally take to be approved? and what all has to be done before surgery can be done.

And finally, 20 years ago, I did go through the Gastric Banding. Can the Gastric Sleeve be done since that had been done? Thanks for any answers.

Cocojohn

[KaiserKid 81]

That language makes it sound like cosmetic surgery isn't covered - like Excess skin removal. May want to call and ask specifically about the weight loss surgery itself. The "not limited to" part can get kind of tricky and they may try to pull a fast one on you with an initial denial, which can always be appealed by your surgeon.

[Diana_in_Philly 1,426]

Every policy is different. Call your carrier and ask for an explanation about whether Bariatric is covered and then ask them to mail you the specific policy provisions they are basing that information on or send you a link to where it is in your policy online. That's the only way you will get this question answered properly. Then call a week later and talk to another rep and see if you get a different answer. If the answers are different, ask for a supervisor. Good Luck.

[orionburn 1,023]

Your bariatric team should be able to assist as well. Keep in mind that policies can vary. Two companies could have BCBS and one cover it and the other not. Call directly and speak with a rep. My insurance website said it didn't cover the sleeve (only bypass), but turns out they did cover the sleeve. My main nurse/assistant at my clinic was a huge help in walking through the insurance questions.

Approval times are going to vary as well as any program you may be required to go to. I have Anthem and they mandated that everyone go through a 6 month program before being approved. So depending on your policy you could be eligible in two months or 6 months from now.

[courtneyd 59]

Sounds like theyre referring to cosmetic surgery.

You can call the 1800 number on the back of your card and ask for details, though.

[cocojohn10 0]

On Wednesday, March 29, 2017 at 11:23 AM, KaiserKid said:

That language makes it sound like cosmetic surgery isn't covered - like Excess skin removal. May want to call and ask specifically about the weight loss surgery itself. The "not limited to" part can get kind of tricky and they may try to pull a fast one on you with an initial denial, which can always be appealed by your surgeon.

[cocojohn10 0]

Thank you all for your input....

I did actually called my insurance company...When I asked her about my coverage she read that quote word by word....when I asked her of criteria to by approved....she said my Dr knows these. Also, she said that she can't give me this info, because then you can use that info and tell your Dr, you have these issues to be approved....

So I have to wait until my Dr sends in my Medical Records....

Thanks again all your feedback.I'm really liking this forum..people seem to want to help.

Cocojohn