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GHI & BCBS

camille01

By camille01, in Insurance & Financing

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camille01    2

camille01
Posted

I am just wondering if anyone has ever went through GHI and BCBS because I am almost through my appointments,I was wondering if anyone has been approved through GHI-ppo,and the time limit that they have waited on the approval,I am not in a hurry but I dont want to have to wait,I am ready to start my journey with my new friends so that we can share our stories....

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Nikki_D    28

Nikki_D
Posted

That is so funny because BCBS is my primary insurance and GHI is my secondary. I'd like to know the answer to that as well.

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Chicadee    10

Chicadee
Posted

I received a call from my surgeons office just last week that BCBS of CT is now considering the VSG an acceptable form of surgery. Previously it was not covered at all in CT with them. I'm so glad I don't have to consider having a band now instead.

Not sure where you are located but perhaps they are accepting it in several other states as well.

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camille01    2

camille01
Posted

I received a call from my surgeons office just last week that BCBS of CT is now considering the VSG an acceptable form of surgery. Previously it was not covered at all in CT with them. I'm so glad I don't have to consider having a band now instead.

Not sure where you are located but perhaps they are accepting it in several other states as well.

Hello chicadee,I live in NYC,in the Bronx and for teachers there Primary insurance is GHI,and there secondary is BCBS

so I am hoping that I dont have to choose between bypass or the band I want the sleeve...I was wondering how long does it

take them to accept or do the hospital even send in for approval before all the appiontments are complete or do they wait until

everything is complete.I just have a few appointments left,(my neutritionist,3 more wt mgt visits,and my second visit with the surgeon,and i'll be ready for my new journey...thanks for the imput....camille01

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Chicadee    10

Chicadee
Posted

I have completed all of my pre-op appointments, Nutrition, Psych, Cardiologist. I didn't have to have a sleep study because I already know I have sleep apnea. I have to give my primary Dr consent letter to my surgeon and then they can submit for approval to the insurance. I have no idea how long it is going to take them unfortunately. I may know more on Friday, I am going to the surgeons office to speak with the on staff nutritionist because they want me to lose weight before surgery.

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camille01    2

camille01
Posted

Thanks Everyone for the input,I know now I have to wait for all of the appointments to be completed for all the info to be submitted at the same time for approvel,I still have 2 more months for wt management,a nutritionist visit,and another visit with the surgeon,I guess this is the one to make sure that you know what you want(surgerys),I am glad that they are taking the precousions because this is something that shouldnt be taking litely....I appericate the staff that I will have when I do have the surgery.....I have the biggest part over,now its the little things that are holding me up....I guess it takes paitents and lots of them...I have a drawer full of it...lol........keep us posted...

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camille01    2

camille01
Posted

That is so funny because BCBS is my primary insurance and GHI is my secondary. I'd like to know the answer to that as well.

HI Nikki,I contacted GHI and got a chance to talk to one of the reps.she had me to contace the doctor for the surgery CODE,I did and called them back,she told me that the sleeve is covered but its is up to the surgeon and your PCP.they have to issue a medical necessity letter to the insurance along with the other appts.

we had to complete like the psyc,nutritionist,Gallbladder x-rays ant the other test to see that we quilify.....thats what they told me....I hope this helps...

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krenee    8

krenee
Posted

I have GHI/BCBS Camille, and they initailly denied my claim. my surgeon is in the process of doing the peer to peer appeal. So wish me luck.....I am so frustrated.

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SkinnyOnMe    81

SkinnyOnMe
Posted

I have GHI/BCBS Camille, and they initailly denied my claim. my surgeon is in the process of doing the peer to peer appeal. So wish me luck.....I am so frustrated.

WHat was the reason they denied you? I am trying to gauge whether or not I am going to run into problems.

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Hibmirn    0

Hibmirn
Posted

My doctor is doing the Peer to Peer Review. I have GHI/BCBS and was denied twice.

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krenee    8

krenee
Posted

If you don't mind me asking, what was the reason for the denial both times????

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Hibmirn    0

Hibmirn
Posted

First it was the lack of a physician other than my surgeon recommending the surgery.

The sleep apnea doctor submitted his report with the recommendation for wls.

My pcp supervised the diet and I spoke monthly to a nutritionist.

They then stated that they did not get a letter from the pcp for medical necessity.

It is alot of BS. They just don't want to pay. Hopefully I will hear something positive soon.

Two different letters with two different denials. Satisfied the first and they added another requirement on the second. RIDICULOUS!!

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