hey everyone so i called my insurance today to ask what the criteria was for approval and they said they could not give me that information. they said my dr would have to submit the papers, thing is I dont wanna go through tons of blood tests etc just to find out im not eligible. If anyone knows the criteria for BCBS PPO please let me know

thanks

I have BCBS PPO although it may be different depending on the state and benefits.

Qualifications:

• 40+BMI
  
• 6 month Dr supervised diet or records from a diet plan (example: Jenny Craig, Weight Watchers, etc.) within the last 2 years OR Two - 3 month Dr supervised diet or records
  
• Pass Psych evaluation
  
• Overweight for more than 5 years
  

Hi, yes I too have BCBC PPO. I was able to show that I had done tons of diet plans so that counted towards my six months. I had to do the the psych eval, internist eval and surgeon eval that I believe we all go through. They also required me to do a one time consult with a registered dietician... which I am glad because she gave me great ideas. Good luck. I'm also in San Diego...

I have BCBS ppo and did not need a six month diet.

I have BCBS as well. I dont know if it matters that its BCBS FEDERAL but here's what i had to do::

1. Have a BMI of over 40

2. Had to be overweight for 5 years or more

3. Have proof of different weight loss attempts(weight watchers, etc.)

4. My PCP had to write a letter saying that i qualify for the surgery according to weight issues, etc.

I believe that was it as far as i can remember. My surgeon had his own requirements that i had to do as well.

It took BCBS almost two weeks to approve it. But the surgeon also put on the paperwork he submitted that it was MEDICALLY NECESSARY. I have my Pre Op August 18th & my surgery on August 27. I think altogether it only took a total of maybe 2 months for everything.

I hope this helped out. Good luck with everything! Let us know how it goes!

Oh also, i didnt have to do any 6 month diet or have to lose anything before the surgery or do any Pre Op diet.

Edited August 17, 201016 yr by mybarra4
left info out

I have Blue Shield of California. I'm a little worried about proving I've been over weight for 5 years. I didn't have insurance during college so I could probably only go back 2-3 years. I don't know if my insurance has that 5 year requirement....and really I'm not sur if BSBC is the same as BS of CA. I have an appointment with my surgeon schduled for Sep 16th.

I have BCBS and I didn't need any of the things listed abov2. I've only been overweight for the past 3 years (gained a ton of weight when pregnant and some extra weight), I didn't do a six month diet or anything. I met with my surgeon on 6/2 and had my procedure 8/16 and once all my paperwork was in they submitted it to insurance and I was approved the very next day. I don't really think you can really follow anyones process, just know that there's hope.

I wrote a three page letter of attempted weight loss since the age of 15 to now 38. It helped in the previous weight loss attempts. You can write your own letter and give time frames.

~jennifer

I have BC/BS of Iowa- and its a PPO. I was just denied surgery. They stated that I wasn't @ a 40% BMI for the past 3 years. I weigh 269 and I'm about 5 5 1/2. I also didn't have any "proof" of past diet attempts in my dr's records as really the only time I went was when I was sick. We didn't discuss my weight.I am waiting for my denial letter so I can appeal it. Not only am I morbidly obese now- I'm pre-diabetic, Hypertensive and have high cholesterol. Both my PCP and a cardiologist stated that it was highly reccommended.. Anyone have any ideas how to change their decision?

I have BCBS ppo and did not need a six month diet.

Yea, they changed that requirement.

Just to let you know I think you got a CSR on the phone that just didn't want to do their job! I called BCBS PPO of Texas before I went to the lapband Dr. to get the requirments and it took her a min to look it up but she found it and told me. The person that you spoke to probably just didn't want to take the time to look for the info.