BCBS Fed/Texas Approval requirements

Mel34 · September 26, 2011

Hey y'all!!

I just started my process about 3 weeks ago and I have BCBS Federal. I was wondering if anyone can help me out with specific details about what I, personally" had to hand in to my doctor/coordinator during my 3 month weight management. For example, food journal, excersice log, etc...

Another question, My BMI is exactly 40 right now. Can I afford to lose a couple of lbs and still get approved? Or should I just maintain my weight??

I would appreciate anyones knowledge and experience about this!!

firefighter2621 · October 3, 2011

Hey y'all!!

I just started my process about 3 weeks ago and I have BCBS Federal. I was wondering if anyone can help me out with specific details about what I, personally" had to hand in to my doctor/coordinator during my 3 month weight management. For example, food journal, excersice log, etc...

Another question, My BMI is exactly 40 right now. Can I afford to lose a couple of lbs and still get approved? Or should I just maintain my weight??

I would appreciate anyones knowledge and experience about this!!

Im not exacally sure about BCBS Federal but I have Empire BCBS and I live here in Texas. I will tell you that for me, as of today, first before I could see my doctor I had to schedule a seminar explaining the lap band/sleeve procedures. Once I decided to do it I scheduled an appointment with my doctor. According to my insurance I had to have a bmi of 40. I was at 39.5. We put my wifes purse on the scale with me to bring me up to 40. After the initial appointment I had to go see a phychatrist (sorry if I misspelled) . At first I thought that was all I was going to have to do but then I was informed that I had to go see a nutritionist. Since seeing the nutritionist, all of my information has been submitted to my insurance for approval. I got a call on Friday from the insurance but I was unable to talk with them. I have to call back sometime on Monday. Once I am approved I wll have to pay $250 out of pocket for a 4 hour class that is mandatory. Then I will have to go on a 2-week Protein diet. Have your doctors office throughly check over your insurance. At first I was going to have to do 6 months of dieting. Then it was 3 months. In the end Empire BCBS changed their requirements and I dont have to do anything. I hope this helps you out a little. Good luck to you.

Steve

Mel34 · October 3, 2011

Steve, thanks for the info. I have a question... When did u start it process? and do u knoa what changed that u didn't have to go through the 3/6 months of doctors supervision? when r u scheduled for surgery?

Melissa

firefighter2621 · October 3, 2011

Steve, thanks for the info. I have a question... When did u start it process? and do u knoa what changed that u didn't have to go through the 3/6 months of doctors supervision? when r u scheduled for surgery?

Melissa

Both my wife and I had our first appointments at the end of July. We are currently still waiting on insurance approval. The insurance has had our info for at least 2 maybe 3 weeks. As far as the insurance goes Im not quiet sure. We were told originally that it was going to be 6 months of doctor supervised diet. My wife told the lady that one of her co-workers only had to do three months. The lady went online and looked at bcbs and they had recently changed it to where no dieting was necessary. She called bcbs and verified that info. Just a work of advice check with your provider. From what I understand not all bcbs are the same. I have seen where some people have it and they recently went from 3 months to 6 months of dieting. I am hoping that we find out some good news hopefully as soon as today.

beachlover09 · October 19, 2011

Hey y'all!!

I just started my process about 3 weeks ago and I have BCBS Federal. I was wondering if anyone can help me out with specific details about what I, personally" had to hand in to my doctor/coordinator during my 3 month weight management. For example, food journal, excersice log, etc...

Another question, My BMI is exactly 40 right now. Can I afford to lose a couple of lbs and still get approved? Or should I just maintain my weight??

I would appreciate anyones knowledge and experience about this!!

Congrats on the start of your journey! I have Basic Federal Blue Cross Blue Shield, and I had surgery in Texas. My doctor just documented that I came into his office for weight loss management. He provided the insurance company with a letter explaining that the surgery is medically necessary, provided my weight history for the past two years, and listed the diets I have tried within the past five years. It was a one-page letter. The beginning of the entire process was a breeze. It got really annoying once my surgeon's office turned in everything to the insurance company. It was submitted August 21. They sent a letter to my surgeon on September 7th requesting documentation of the nutritionist visit (that was already submitted). We didn't get the letter until September 16th, and it was re-submitted. I called the insurance company on September 19th to make sure everything was okay. They said that I was approved. My surgeon's office called, and they told them the same thing. So we scheduled the surgery for October 3rd. On September 29th, my surgeon's office called for a pre-certification (something they do a few days before the surgery). BCBS said that I wasn't approved, and they are waiting for the further documentation. After we provided a "approval code", they said it was a "reference" code and not an approval code. Needless to say, I wasn't actually approved until a million phone calls later - the Friday before my surgery on Monday. I was a wreck - had been on a liquid diet for two weeks not knowing if I was even going to be approved at the last minute. SO, my point is - stay on top of everything. When you call, get a reference code to each conversation. When they say you are approved, have them fax you a copy (the mailing takes forever). If you have any questions, feel free to contact me. I am two weeks out, and would do every single thing all over again. I'm down 25 lbs since the beginning of my pre-op diet. Such an amazing feeling! Good luck with everything!!!

Mel34 · October 21, 2011

Congrats on the start of your journey! I have Basic Federal Blue Cross Blue Shield, and I had surgery in Texas. My doctor just documented that I came into his office for weight loss management. He provided the insurance company with a letter explaining that the surgery is medically necessary, provided my weight history for the past two years, and listed the diets I have tried within the past five years. It was a one-page letter. The beginning of the entire process was a breeze. It got really annoying once my surgeon's office turned in everything to the insurance company. It was submitted August 21. They sent a letter to my surgeon on September 7th requesting documentation of the nutritionist visit (that was already submitted). We didn't get the letter until September 16th, and it was re-submitted. I called the insurance company on September 19th to make sure everything was okay. They said that I was approved. My surgeon's office called, and they told them the same thing. So we scheduled the surgery for October 3rd. On September 29th, my surgeon's office called for a pre-certification (something they do a few days before the surgery). BCBS said that I wasn't approved, and they are waiting for the further documentation. After we provided a "approval code", they said it was a "reference" code and not an approval code. Needless to say, I wasn't actually approved until a million phone calls later - the Friday before my surgery on Monday. I was a wreck - had been on a liquid diet for two weeks not knowing if I was even going to be approved at the last minute. SO, my point is - stay on top of everything. When you call, get a reference code to each conversation. When they say you are approved, have them fax you a copy (the mailing takes forever). If you have any questions, feel free to contact me. I am two weeks out, and would do every single thing all over again. I'm down 25 lbs since the beginning of my pre-op diet. Such an amazing feeling! Good luck with everything!!!

Oh, my gosh!!! Thanks so much for the heads up!!! I'm really going to stay on top of everything!! I'm keeping my own documentation of everything I'm going through, as far as medical appointments and such. I can't wait to get my surgery!!! I just saw the nutritionist yesterday, so that's one more thing checked off my list. I'm hoping and praying these next 2 months go by fast!! And believe me, I'm a very impatient person when it comes to stuff like this, so I will be calling and calling and calling and calling the insurance company until I know for a fact that everything is going right! Again, thank you for the advice and sharing your experience. It has really calmed me down!