Ok have a question from a friend of mine... has anybody had to deal wit Blue Cross Blue Shield of Alamaba?? If so how long does it normally take to get approval? and how tough are they on getting approved?

I didn't know Blue Cross covers insurance for an elective surgery. I'll tell my friend about it. thanks!:frown:

through the company they do...but you have to do the 6 month diet thing with the doctor and see a shrink

I have BS/BC of California. I have been banded 6 wks. They covered it 100%. You have to have 40 bmi or a 35 with other issues such as sleep apneia, Diabetic, High blood preasure. They ask for 5 year histioy of dieting. You dont have to show proof of this, so use your best guess. They need documentation of a 6 month medically supervised diet. I t has to be in the past year, but doesn't have to be consecutive. I showed 1 mo. with a medical clinic and a few months later i did 3mos with a Doctor, they counted it as 4 mos and let me do 2 months with dietition at Lap band Surgeons. I did 6 mos in same year I was good to go with that at least. There are several test the surgeon will do. They will get all the paperwork done and send it to BC/BS and then they have 72 hours to give you an answer. I was approved first time. My consultation was jan and I had Lap Band in April. Good Luck

I have BC/BS of Florida, but it is Federal PPO BC/BS. I don't know about everyone else, but I did not have to jump through any hoops to get my lapband covered.

If you were a certain BMI (I believe over 40) all you needed was pre-authorization before the surgery. No 6 months of dieting, no nutritionist visits, no co-morbidities, etc. I think if you were between 36-39, then, according to the plan brochure, you *may* need to meet additional requirements. But, that's on a case by case basis.

BC/BS can vary widely depending on the state and/or plan, so I would tell your friend to look up bariatric surgery in her plan brochure. That will tell you exactly what you need to do to get the procedure covered.

I have BCBS TX (Anthem) and they require a complete a 6 month medically supervised diet and Psychiatric evaluation. My 5th appointment is on Thursday and my 6th appointment on July 8th, I will try and complete the Psych eval between now and July. Hopefully I can schedule surgery before the end of July. Your friend should contact her doctors office and her insurance benefits department to verify if the do cover the surgery before she proceeds. I had Aetna last year and did not qualify because I didn't have any co-morbities. Now that I have BCBS and I qualify. She always has the options of changing insurances if she doesn't qualify with her current insurance.

I have BCBS in PA and I had all the general requirements BMI 40 or more, 6 month diet, shrink, and some other tests once it was all done, i was approved on the first try within 24 hours.

BCBS offers many different plans. I have HMO Blue in MA. Your friend should easily be able to acquire a copy of the policy's (coverage, requirements, etc.). With my plan, I need BMI of 40, or 38 w/ 2 co-morbidities. Anyone w/ HMO Blue, go online to bcbs.ma then to policies....weight loss is covered on page 379, i'm fairly sure.

Teach724-

How long was the process for you? I have BCBS in PA..

I'm just attending a seminar this Thursday and hope to get the ball rolling SOON. I'm a student and trying to get a surgery date by mid-August. Realistic? If not I'll have to wait until winter break!

Thanks!

BCBS/FL with the PPO plan slammed the door on me sending both my wife and I to the self pay lane.

:-(

Hi Teach, I'm new too. Had orientation, met w/ surgeon on june 4. my psych appointment is tomorrow, followed by nursing eval on 22, and nutrition on 29. Back again to surgeon on july 2, where i expect my bmi will be up to 40 (i was a little short, but am fixing that). At that point they'll probably choose a surgery date, and submit my claim to the insurance. I also have to attend 2 mandatory meetings the end of this month, and the end of july. I'm looking at sometime in september. I had to quit smoking too, but i haven't had a butt in three weeks. I'm really excited about this, and i really think this will help me. So, back to you...Couldn't you just schedule your surgery at the first available time? I have heard that the recovery process is pretty easy...some people back to work in a few days.

Meanmom, I have BCBS of WV. I have to agree with Losethemess as her experience fits mine almost to a T. All companies who offer insurance thru BCBS have different stipulations. So while some BCBS cover the surgery (some with requirements and some without) if the company your friend works for does not allow bariatric surgery, it would not be covered. The best thing to do is get with your employer and see what surgeries are excluded. Bariatric surgery is usually explicitly excluded from coverage if that is the case.

Otherwise, the requirements are not that difficult ie, jumping thru hoops. For me, it has just been the waiting. I am so anxious to get going and I've had to wait for six months. (Maybe it wouldn't have been as bad, but I was denied by my previous insurance last September and had to wait till January to start the whole process over again.)

I hope this helps and Good Luck to you and your friend!

I have BCBS of georgia and all i needed was a letter from my Dr. a bmi of 40 or 35 with a co-morbidity and a nutritional consult(just one) , a pysch eval and thats all!!! now i wait for approval!

I have BCBS of georgia and all i needed was a letter from my Dr. a bmi of 40 or 35 with a co-morbidity and a nutritional consult(just one) , a pysch eval and thats all!!! now i wait for approval!

hoping for my surgery in early August

It varies not only by insurance plan, but what her company will or won't cover. Once my packet was submitted to the insurance, it took them two days to approve me!!!

Beachbunny-

I have BCBS of GA too, Anthem, PPO and my qualifications were the same as yours. BMI over 40, nutrition, psych eval, and sleep study. My packet was submitted on 5/25 and I was approved on 5/27! Only need to pay for my 20% portion, but that won't exceed $1500. :> Pretty sweet!!

Good luck to you!!!

Edited June 15, 201016 yr by Mommy2Ps

Firstly realize BCBS of Al owns Alabama. They will approve you but at their pace. You will be required to work thru the 6 mon. period where you r supervised by your Dr. see the shrink, nutritionist etc. You won't be able to pass go untill you run the game. I hated every min of their control and spoke of it often to my friends and family but.....................now my hindsite is 20-20 I think the 6 months of doing what was required and understanding what I was getting into was critical. Banding is not for sissies.......... or folks thinking a just a little thingy...Its a Lifetime committment.