Bcbs Of Nm- Preapproved?

[toya7876 21]

Once I decided to have WLS I contacted a local bariatric surgeon and I signed up for a free seminar. I initially was interested in the LapBand but after the seminar felt that the sleeve would be the best option for me. After the seminar if your were really interested you felt out the patient paperwork and they said they would contact us two weeks later.

The time seemed to be passing slow so on Friday (6 days after seminar) I contacted BCBS and was just asking some general questions about WLS and the representative was a bit rude and really had me thinking it was a no go. The next day exactly one week after the seminar I receive a call from the surgeons office and they scheduled me an appointment for a consultation with the surgeon. My appointment is scheduled for September 7 2012.

I am just curious if the scheduling of the consultation is more than likely a giant step to surgery approval. I don't hear of many attending seminars but if you have had a similar story let me know. Any info is greatly apprieciated.

[Toyaboo22 51]

I attended a seminar and two weeks later had a consultation with the surgeon to discuss what surgery might work best for me. After the consultation, I had to go to my PCP to have the mandatory test ordered and after that was scheduled for my pre-op appt with the surgeon. It wasn't a pre-approval process that I went through. My surgeon's office was not going to submit anything to BCBS until after I paid my money upfront and all the test and nut/psych visits were completed. That was on Aug.30th so I'm not sure when they will submit as my surgery is scheduled for 9/12. The reps at BCBS do seem to be a little rude at times and I've found that they will tell you anything as they really are unsure of things. I would ask them to send you a copy of what all is required and if they cover WLS under your plan. I have a copy of what they sent me if you would like but every plan is different.

[toya7876 21]

Thank you for filling me in. So what test did you have to do with your PCP? Were you able to schedule your nut/psy eval fairly quickly? Did you have to do supervised weight loss or was history and health enough? I will contact them after the holiday and if you dont mind sharing what your bcbs policy required that would be very helpful..

[caroless 18]

I have BCBS of NY and I had the 6 month requirement but had already been on phentermine for 3 out of 6 months prior but they took it with just a letter from my Gyn who had prescribed it. I had my first consult 6/29 and I am a week away! It was submitted and I got approval about a week later. But I do know they need to have all psych/nut/blood/xray/barium swallow/EKG and whatever is required by the surgeon and by the insurance company done and an actual surgery date set before they can submit it. Good luck! Don't stress!

[valdostaGA 149]

I would check with my insurance to see if they even cover wls, because just because u have a consult with a surgeon doesn't mean you'll get approved. Most surgeons have a program fee of $200 and up! So definitely check with your insurance to see if you have coverage first.

[toya7876 21]

I would check with my insurance to see if they even cover wls' date=' because just because u have a consult with a surgeon doesn't mean you'll get approved. Most surgeons have a program fee of 200 and up! So definitely check with your insurance to see if you have coverage first.[/quote']

Yes my insurance does cover wls and I do meet all the requirements. I figured that a consult is not approval but the lady who called and set up the consult seemed very positive and so I just wanted to see if this indeed is one step closer

[toya7876 21]

I have BCBS of NY and I had the 6 month requirement but had already been on phentermine for 3 out of 6 months prior but they took it with just a letter from my Gyn who had prescribed it. I had my first consult 6/29 and I am a week away! It was submitted and I got approval about a week later. But I do know they need to have all psych/nut/blood/xray/barium swallow/EKG and whatever is required by the surgeon and by the insurance company done and an actual surgery date set before they can submit it. Good luck! Don't stress!

See I am pretty sure my insurance does require the six months but when I called bcbs they said the surgeon will have access to the requirements. All my benefits book says is that it does cover but needs pre-authorization. I have had many failed attempts at weight loss at my pcp has monitored me because we tried diet and exercise before bp meds and of course that was unsuccessful so bp meds it is:(...not sure if this past year will suffice as the 6 month requirement or if something more recent will be required. I guess I will find out Friday...thank u trying not to stress just super anxious scared excited nervous etc

[valdostaGA 149]

Oh good luck! I hope they will accept that as the 6 month requirement! I just got approved Thursday with BCBS AL! I started the 6 month diet in from Feb-July and met the other requirements and was approved thank God! I will be praying that you get a positive outcome as well!

[toya7876 21]

Oh good luck! I hope they will accept that as the 6 month requirement! I just got approved Thursday with BCBS AL! I started the 6 month diet in from Feb-July and met the other requirements and was approved thank God! I will be praying that you get a positive outcome as well!

Thank you so much! Congrats and good luck to you. God is good always:)!

[Toyaboo22 51]

Well I have Anthem BCBS and didn't have a 6 month diet requirement. I just had to have nut/psych visit, bmi over 40 or 35 w/comorbidities, surgeon consult, pcp approval, and bloodwork, chest xray, ekg, u/a, and stool sample. I haven't had my approval/denial yet but hopefully everything turns out ok.

[PRL 3]

I have bcb of southern Illinois. The 6 month dr monitored weight loss program had to be within the last 2 years. So you should be good. Bcbsil sent me an information packet and I spoke to one of them and asked them on here phone what all the requirements were. The consultation is probably to get all of your necessary appointments set up. With the psych, nutritionist, etc. I also had to attend a support group session and a couple of additional educational seminars.

I would try calling bcb again and see if they have the requirements for you. If not, the dr office should be able to get that info for you.

Good luck!

[caroless 18]

i would contact someone at the insurance company again to find out that info... that person sounded like they were having a straight bitchy day. mine told me where to find the entire 20 page list of technical coverage information on their website, so surely they can tell you whether it is covered and what is required. there is no reason they should tell you to ask your dr to ask if it is covered. that is nonsense, and you aren't paying them to give you smoke and mirrors.