Hi my fellow sleevers ! My sister wants to know how to go about the first process with this type of insurance. I was sleeved on jan 5 th. just wanted to know if its pretty much get the referral from your doc. He sends it to the insurance Than go from there ? And how much is the co pay for PPO

I had BC/BS Anthem PPO 2010. Wish I could give you advice but BCBS didn't approve SLEEVE surgery until Oct 2010. When did I get sleeved? 9/17/10 Yeah, I self paid since BCBS refused to pay less than two weeks before offically approved. If I knew BCBS would start approving two weeks later, I would have waited. Argh. Thanks for letting me vent.

Good luck to your sister!

PS- I think BCBS has a 6 month supervised diet involved before surgery is approved. Do a search of this topic in top right corner selecting forums. Enter in BCBS Anthem or BC/BS Anthem or similar

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Like what she said down there !!

Some days I can't talk or write...

I have Anthem BCBS PPO, which doesn't require a referral. However your sister should first check her company's WLS requirements if she meets them she can schedule her on appt. with a suregon.

PS - My company didn't require the six month supervised diet which is why she wants to reach out BCBS and inquire if her company cover WLS if so what are the guidelines does she have to meet. Good luck to you sister

I had this insurance last year and wished I had taken advantage of it when I had the chance! I have 3 friends who had surgery, one paid a total of $500 and the other 2 paid nothing at all. I'm not sure what the difference was in their policies though. I do know they had to do 6 months of physician supervised weight loss and meet specific BMIs (40 without co-morbidities I believe)

I had this exact insurance. NO supervised diet, NO out of pocket cost, just the normal blood test, phycisian clearance, sleep study, psych clearance, ekg and off to surgery i went......

Thanks guys much appreciated

I will also add that I had one surgeon office try to force me to do the 3 mths because she didnt want to hold the line and get the specifics of my policy. I call UM Dept myself and the told how to print out exactly what was required so I would have a copy.

I have Anthem Blue Cross CA PPO. I had to get a referral from my PCP then I went to the bariatric surgeon. He then referred me to the psych and nutritionist contracted with him and my insurance. They submitted my paperwork and I was approved in 3 days. U only need the psych and nutrition appointments prior to having the paperwork submitted. I have my surgery on March 7. I'm not sure what the out of pocket will be. I was told I just had to meet my deductible.

That's weird I wonder why some need a referral and some don't ? I thought if u have PPO u wouldn't need one. Only for Hmos

Every policy is written differently

It wasn't technically a referral. My PCP just gave me the names of the in network bariatric surgeons.

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It wasn't technically a referral. My PCP just gave me the names of the in network bariatric surgeons.

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And then u just make an appt to see them ?

And then u just make an appt to see them ?

Yes.

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I have BCBS and they do not cover WLS on my policy coverage.

Every company's co pays and coverage is different.

She will need to get her medical coverage benefits book from her company.

Hope she finds out good news!!

I went self pay

Apparently every policy is different. I have BCBS Anthem of CA and I did not need a referral I know they have recently changed their policy. I have to have 3 months nutrition appts.