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I had my surgery on 1/15. BCBS Fed is my insurance. When we called before my surgery to get the preapproval, they told me and my dr. they no longer do preapprovals, whether it be GNY or lapband, that you have to have the surgery and then submit your claim. In my case, that meant paying as a self-pay upfront. We are now waiting on approval.
What they did tell us were the conditions that you had to meet, but again, they couldn't make a determination until after the surgery. The conditions you had to meet were a bmi of 40 or over, or a bmi of 35 with obesity-related ailments, 5 years of conservative dieting, i.e. ww, atkins, exercise.
I asked our rep if you had to have the diets documented b/c I have done ww enough to know it like the back of my hand (just didn't succeed for very long) and didn't attend the meetings. She said no. I asked her did it matter that I didn't have medical records with my primary dr. indicating I had dieted or was trying to lose weight (b/c if I'm not sick, I don't go to the dr.), she said no.
So because I had a BMI over 40, had dieted my heart out for the last 10 yrs, meeting their conditions, both dr. and I felt confident that BCBS Fed would pay. Just found out this morning that my anesthesiologist bill, $1,000, was denied b/c ins. said it was not necessary. Whatever that means. The rep volunteered to have that claim re-reviewed. The claim for my surgeon and hospital are still under review w/out a determination.
I don't know if this helps or not. I wish you good luck!