I was wondering for those of you who have BCBS insurance if you had to get the Gastroscope to check for Gastritis? And if so did you have to have the condition for BCBS to accept you? My doctor made it sound like my insurance company which is BCBS of IL requires you to have the condition before they will pay sounded a little weird to me...

I was wondering for those of you who have BCBS insurance if you had to get the Gastroscope to check for Gastritis? And if so did you have to have the condition for BCBS to accept you? My doctor made it sound like my insurance company which is BCBS of IL requires you to have the condition before they will pay sounded a little weird to me...

I have BCBS in Maryland (although it's a National Account). required just the standard tests and the 6 month wait with demonstrated weight loss during the 6 months.

Approved right away. Pre-approval 6 months ago and final approval taday when i got my date.

I think alot has to do with what employer your insurance is through.

Hey everyone. Thanks for all the replies....much appreciated!

I did talk to an insurance gal today about this and she reassured me that NO BCBS of IL does not require this procedure YIPPY no more stress over that one....

BC/BS may not require the endoscopy be done, but your surgeon might. BC/BS of Ohio does not require an Upper GI, but my surgeon would not operate without every patient having one done.

Hope you don't need to. I've heard you are knocked out during it, so it shouldn't be too bad.

BCBS of Idaho excludes any WLS.

The requirements for BCBS Illinois are different than other BCBS plans. You do not have to have gastritis and do not have to have the scope done. My surgeon's office initially said I had to have it. I checked with the insurance company and they said I didn't. I told the surgeon's office this and they told me I was wrong but in the end, after they checked, they found out I was correct. It seems the BCBS Illinois requirements are not as strict as other BCBS plans.

I have Empire BCBS, and like Nikkirose, my doc's office made it sound like they didn't actually need 'pre-approval' either. Because it can be done on an outpatient basis, no pre-cert was needed. And if I decide to stay overnight in the hospital, or if the doc makes that decision, then it will be up to the hospital to get the approval for that.

I thought that most BCBS plans worked about the same in every state? It seems odd to me that BCBS in PA will cover it, but another state won't. Hmmmmm. Maybe you could go to their website and see what you can find on coverage for Bariatric surgery.

What a lot of people don't know is that Blue Cross Blue Shield sells the rights to use their name. So, each insurance company is independently owned and operated (think franchise chains) ... And within each company, there are different policies to purchase and different medical guidelines based on either an umbrella policy or specific requirements by the group (employer) who purchases insurance.

So, just because you have a friend with BCBS insurance even in your same state, you cannot assume you have the same type of benefits, coverage, or medical policy. That is why it is so important to know your benefits, document your discussions (including names) of an representatives you talk to and ask for written confirmation of your conversations/decisions made for your benefits.

That's true! Actually, when I called BCBS of Michigan, I talked to a really nice guy, who was very helpful. He looked at my company's contract and said it was weird because they said "Gastric Stapling" is covered. He said it's weird since no one really does "Gastric Stapling" anymore, but my company's contract was set up many years ago, when that was the way to go. At that point, he couldn't even say if the Lap band (which was what I was looking into back then) was covered. He actually called around and talked to supervisors to find out what that means and got back with me a few days later telling me it covers the band but no one had updated the contract my company has with BCBSMI. By that time, I had gotten away from the band anyway and moved towards the sleeve.

What I am trying to say is that the only thing that you can really count on is if YOUR INSURANCE which is listed on THE BACK OF YOUR INSURANCE CARD with a number that YOU SHOULD CALL tells you something. No one else can give you any real solid information that you can rely on.

I have BCBS of Alabama and they don't cover any type of WLS. I was self-pay so I didn't have to do that procedure. Each BCBS group is different.

FYI: I have BCBS of Alabama "Federal" and they do cover all WLS, only thing that changed since 01/2011 is they now require 3 month diet. I'm not saying the previous info is wrong cause I've only had the federal plan, but I would call and ask. . .they even gave me the correct code my doc should use in order to get approval.

I don't believe that BCBS of CT requires that procedure either but it is something my surgeon wants me to do. I have to call the Gastroenterology office tomorrow to schedule a consult. The PA at the doctors office says he makes all of his RNY patients get it so he is also making all VSG's get it now too.