Blue Shield Denial - so upset

[Breesmom813 0]

Nobody in member services ever told me that. Im on the website right now for the insurance provider as well as 3rd party HR service that coordinates the insurance and nothing about guidelines. Maybe I'm missing it but if its this hard to find, that's sounding very unfair to me. I'm logged into our website and looking at everything related to our exact plan.

[LipstickLady 25,682]

I asked for the medical plan details specific to WLS be sent to me. They emailed,mailed and faxed it. I wanted the requirements in hand so I was relying on mysel, not the doctor or the caseworker assigned to me by BCBS.

[Olarance75 215]

I work for bcbs of mi and the 6 consecutive months are clearly documented in the medical policy on gastric bypass surgery. I pulled the policy and read plus plenty of my co workers have had surgery so they helped me

[Breesmom813 0]

I found it but only because I typed in "blue shield of California medical policies" Yes, it's clearly stated if you know where to find it, which I did not and nobody helped me to find it. This is the part I feel is misleading and unfair.

Anyway, moving on. Hopefully 6 months will go quickly. In the grand scheme of things, not a huge deal but I won't take full responsibility for this error.

[Reviewer 20]

I just received an email from the coordinator advising me not to worry about providing past proof. She went on to say that during my initial appointment next week the doctor will ask me about past attempts and document them. That documentation she says is what BCBS requires to verify past weight loss attempts. She also mentioned that she has dealt with my BCBS group in the past and that the doctors documentation was sufficient.

[Kasey Parker 31]

BCBS of NC is changing their policy on the 10th to require 6 months and I read the new policy and it says "frequent, monthly" but not the word consecutive so I'm going to ask the surgeon when I go the 18th. I have 6 months worth in the last year but not consecutive (Sept-Dec '12, Aug & Sept '13). My doctors really trying to help me out too.

[JulieF 16]

Kasey-have you had any dietician visits during months when you did not see the doctor? My doc co-signed the dietician notes when I had missed a monthly dr visit. Just a thought!! Good luck!

[kayel8ch 1]

I have BCBS NJ, they would not provide me with hard copy of the policy requirements, I had to write them down as they read them to me. However, I had to submit the required documentation to my husbands union benefit office, then it goes to a review board to prove medical necessity. Then to the board of trustees to decide if they are going to open up my benefit. Then the trustees tell the insurance company to pay for my surgery and hospitalization. Quite a circus. Been working on this since December. And still have another 6 months of the supervised weight loss, before resubmitting. And waiting....

[Brighteyes 237]

I have BCBS federal. It specifically says I have to do 3 months consecutive visits with my PCP for supervised weight loss. The PCP can't be associated with the surgical facility doing my surgery. It's a tough blow. I have had a few set backs myself because of a bad PCP so I understand how disheartening it can be. Talk to your insurance company, have them go over the requirements with you over the phone and send you a copy of your benefits package that explains your coverage. Good thing is you'll still get to have the surgery even if its not when you wanted.

[Sdunn1980 33]

I have BCBS NJ Direct and didn't have to show supervised weight lose for any amount of time. From my first visit to the day I had surgery was only about 2 months.