Jumanna

I have BCBSKS and got an approval a couple of weeks ago. Then a nurse from BCBS called me and said that in a few weeks they would "interview me" in which i would give them my height and weight. I have lost about 9 lbs since my last class for the approval process and am afraid they will find ways to deny me this late in the game. I already have a surgery date ready to go but also know insurance have done last minute denials to people in the past.

Do any of you have experience with that and if so - should I be worried? Thanks.

I have been anticipating a denial for some reason but my case manager called me and told me i was good to go. I honestly couldnt even comprehend what she was saying because I was so excited. LET'S DOOO THIIISSSS!!

1 minute ago, VSGSLAYER said:

I also have BCBS they submitted mine paperwork Thursday andi got my approval today so good luck and best wishes to you on your journey

did you get approved??

On 4/16/2018 at 9:43 AM, All4Russ said:

I am with you. I will have my last nut appointment next week and then they will submit everything... I am so nervous that something will go wrong and I will be denied. I think it natural to worry.

Keep me updated on everything! good luck

On 4/16/2018 at 1:45 PM, Frustr8 said:

And when someone,in something denies you, you will,sit and cry your eyes out. That is so much me I have the jacket to prove it. I was blindsided, thought if you were fair and honest with someone, it would only be to,my benefit. Wrong! But I was one of those infrequent happenings, you all will not,be!! And I will taste victory and I have to believe,you will be sweeter for the wait.😁

Leading others to happiness is the greatest triumph.

your kindness will get you far in life, thank you for your sweet thoughts! we got this <3

On 4/16/2018 at 11:38 PM, J San said:

I had that feeling from day 1. I went to my surgeon to see about him fixing a hernia I currently got (1st time) and he suggested the sleeve because he could fix the hernia but because of my weight there was a strong chance of it just re-opening or another opening somewhere else. I had talked about bariatric with my Primary Doc but it was nothing more than a suggestion from her and a nod "i'll give it some thought" from me. After getting a bit excited when I left the surgeon it hit me. Would be just my luck go through everything and insurance says No Go.

I'm sure all will go well for you and all others waiting to hear, myself included (fingers crossed).

Either way keep up posted on updates and best of luck!!!!

J

GOOD LUCK TO YOU TOO!! thanks for the support,! and i will for sure keep yall updated!

14 hours ago, Frustr8 said:

@Jumanna have you heard anything about your insurance approval yet?😗 Thought maybe you would have good news for us😛

Hello!! Yesterday my program specialist needed to clarify a document with me - that is all done and she said that she would send everything to insurance by today or tomorrow. hopefully I will know by next week (BCBS is typically fast from what she told me) I will keep you all updated! thank you for the support, I will let you all know soon <3 <3

My insurance acknowledges GERD as a comorbidity, and its the only one that i have! from what i know and what my program specialist has told me I dont have to do any additional tests. I just dont have the original documentation that diagnosed me with GERD - however, my PCP put that comorbidty on my clearance form. I just hope insurance doesnt dig any deeper!

I am in the process of getting things together to send off to insurance. My insurance requires me to have one co-morbidity and mine is GERD - the problem is my brother in law, who is a PCP, told me that I have it. I was not his patient or anything, he was just over my house to help me out and took me to get OTC medication for it. I arises sometimes still. My current PCP signed off on it but I am afraid that insurance will want proof of my original diagnosis of GERD (two years experience with it to be exact).

If my PCP signed off on it, will insurance require me to give them original documentation of it from 2016? Like I said, I dont have any documentation because my brother in law told me I had it. I just dont want that to be the reason that I dont get an approval. What do you all think?

I did everything included in my multi-disciplinary program through the hospital, passed the psych eval, attended all my classes, and got clearances from a couple of my doctors! NOW IT'S TIME TO GET EVERYTHING SENT. I have a sinking feeling like somehow I will get denied still?? Is this normal? Cross your fingers for me, yall!

23 hours ago, frust8 said:

Words on old sign Don't tie yourself up in "nots". don't worry about things not being right. You have done things properly, have the courage of your convictions. Stop worring, start smiling kick back a little and relax. Tensing yourself up serves no useful purpose, sadness only brings wrinkles and indigestion. Rechewing your words, nope start beleving in you, each thing on the requirment list prepares you for your future surgery and you will, in the fullness of time have it occur.

Sent from my VS880PP using BariatricPal mobile app

you are so kind!! thank you <3

I have my last class before getting all my paperwork submitted to insurance and I am freaking out and over thinking things way too much. I have my psych eval coming up but other than that everything is ready to be faxed to my case manager. I read over the bariatric rider every day making sure I qualify but even then the uncertainty of getting denied after all this time and money dedicated to getting this surgery is too much. Any recommendations on how to disconnect and relax over this entire thing? thank you.

I am in the last month of my weight loss classes to meet medical necessity and my bariatric rider states that I need to have one comorbidity on top of having a BMI over 40. I got diagnosed with GERD in December and was wondering if that would help me meet that criteria? Although I do understand that some docs dont want you getting the surgery if you do have GERD. What do you all think?

27 minutes ago, shelleycakes said:

You're not being treated for high blood pressure (hypertension)? With a BMI of 46, you'd only need to meet one.

If you don't meet their criteria it is likely you won't be approved. Have you talked with your Dr, they may have a plan when submitting for approval.

I am on and off with having high blood pressure, some days it's good and other days it's high. Overall it's not that severe. when i saw my doctor he just gave me an 'okay' to do surgery, didnt go too into detail about other comorbidities. i took and cholesterol test and lipid panel and my numbers were pretty normal. my main issue is how obese I am and heart disease/diabetes running in my family. idk what else to do but i really need this surgery and want to avoid getting denied.

Hey everyone!

I am currently in a 3 month program at an in-network hospital to do my surgery.They accept my insurance but as I am reading over the rider it states this as meeting requirements to be qualified:

"To be eligible to begin the qualification process You must be an adult age 18 or over, a non tobacco user and have a documented medical history of two years or more of a Body Mass Index (BMI):

 Equal to 35 and less than 40 with two or more co-morbid conditions

 40 or over with one or more co-morbid conditions"

under the definitions tab they have this as a co-morbidity:

"Co-morbid conditions: Means for the purposes of the Bariatric Surgery benefit, the following chronic health conditions:  Cardiomyopathy  Type 2 Diabetes  Coronary Heart Disease  Hypertension  Gastroesophageal reflux disease (GERD)  Clinically significant obstructive sleep apnea"

I am afraid that since I do not have any of those conditions I will not get approval for my surgery. My mother's side of the family has a history of diabetes while my father's side has a history of heart disease and cholesterol.

I am doing so well when it comes to getting all the proper requirements for my insurance. I'm getting a bariatric psych eval next week as well as finishing up my last month of classes at the hospital. Does it seem hopeful? Thank you!

Clarifications: I have Blue Cross Blue Shield of Kansas and this is my rider: https://www.bcbsks.com/CustomerService/Members/State/pdf/2018_BCBS_PLAN_C.pdf

Current weight: 285 BMI: 46