Misha42000

My surgical coordinator made a mistake and called yesterday. My surgery will be on 06/12 and not 06/02. I'm still happy because it's only one week further than my original date and I am still having it done. Can't wait for the new ME!

I have BCBS of PA and it took 1 day for approval but they had up to 15 days to decide. look at the back of ur insurance card and go to their website a look for the medical policy and type in gastric sleeve and you should see the requirements there.

I'm so happy for you

I'm so proud of YOU! I'm ecited for this next chapter for all of us. Thank you for sharing ur story.

thanks but call ur insurance to check the status of ur approval.

I have Highmark BCBS of PA and My paperwork was submitted last thursday 05/18 and my surgeons office call me the next day to say I was approved. I'm so excited and can't wait for my surgery which is scheduled for 06/02.

Mine is alos June 6th

I was shocked on how quick I got approved, it took only a day

I finally got approved by Highmark BCBS. It took them only one day to approve me. I started my journey in March and I completed everything on 05/08. The surgeons office just called and my surgery is on 06/02 I start my pre-op liquid diet on 05/21! Words can't explain how happy I am. My starting weight was 262 and im 5'2. I know weigh 226 a=so my BMI is still over 40. I'm am excited for this next chapter

Check your medical policy coverage for the procedure. It will outline what is needed from you to qualify and be approved for ur surgery.

I'm right there with you and know the feeling. I have finished everything and im just waiting for my surgeons office to review everything and submit it to my insurance for approval. I have so much anxiety for it all.

I really liked it. Thank you for sharing.

You look Great! Congratulations

So I have Highmark BCBS and I have completed everything and had my pre-op appt with my surgeon this pat Monday 5/08/17. She said they would be submitting everything to my insurance for approval. Today is Friday and I found out surgical coordinator has been out sick all week (God bless her soul) but the wait is killing me. I'm so anxious and worried I may not get approved. Patient Selection Criteria for Adults The patient is morbidly obese and is at least 18 years of age. Morbid obesity is defined as a condition of consistent and uncontrollable weight gain that is characterized by a weight which is at least 100 lbs. or 100% over ideal weight or a BMI of at least 40 or a BMI of 35 with ANY ONE or more of the following comorbidities: Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of 3 anti-hypertensive agents of different classes); or Cardiovascular heart disease (with objective documentation by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, CT angiography, coronary angiography, heart failure or prior myocardial infarction); or Hyperlipidemia; or Diabetes mellitus type II; or Obstructive sleep apnea (OSA); or Obesity-hypoventilation syndrome (OHS); or Pickwickian syndrome ( a combination of OSA and OHS); or Nonalcoholic fatty liver disease (NAFLD); or Nonalcoholic steatohepatitis (NASH) Patients should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. However, there is a lack of evidence on the optimal timing, intensity and duration of nonsurgical attempts at weight loss, and whether a medical weight loss program immediately preceding surgery improves outcomes. The patient must complete a psychological evaluation performed by a licensed mental health care professional and be recommended for bariatric surgery. The patient's medical record documentation should indicate that all psychosocial issues have been identified and addressed; and Patient selection is a critical process requiring psychiatric evaluation and a multidisciplinary team approach. The member's understanding of the procedure and ability to participate and comply with life-long follow-up and the life-style changes (e.g., changes in dietary habits, and beginning an exercise program) are necessary to the success of the procedure. If the patient does not meet ALL of the patient selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. Procedure Codes 43644, 43770, 43775, 43843, 43845, 43846

I'm still trying to get in touch with surgical coordinator to confirm she sent my paperwork to BCBS for approval.

I'm so happy for you. I have Highmark BCBS and I completed everything that was required in about three months. I saw my surgeon for a pre-op this past Monday and she walked me down the hall and stopped at the surgical coordinators office, except she was at lunch but my surgeon put everything on her desk and said she will submit to my insurance. So now I am anxiously awaiting approval.

I'm so happy for you and may God continue to bless your marriage and your journey.

I would have the psychologist's office call her because this is important and can't wait for her to return.

I'm so happy for you. I'm waiting on approval from my insurance.

I did mine through my PCP and she referred me to a bariatric program as well. The nurse coordinator at the bariatric center told me what I needed and my PCP sent them everything I had been doing with her. My paperwork get submitted to my insurance sometime this week.

Can anyone with Highmark BCBS of PA tell me their experience with insurance approval?

Is there anyone being seen or had their surgery at Montgomery General in Olney MD?

I have Highmark BCBS of PA and I am submitting my paperwork to the insurance company today, well my doctors office is. I pray I get approved I pray we all get approved

Hopefully she will approve it. All this has my anxiety through the roof. I have completed everything and on Monday they will submit my paperwork to the insurance. I hate the waiting game.

Did she say that she was going to clear you and recommend you for surgery?