Blue Cross Blue Shield Battle

[kanknrysmom1 3]

I am almost at my 4th consecutive appointment I need with my Primary. It has felt like forever to get to this point. I have got through the entire program of dieticians and Psychologist and Physical therapists and seminars and support group. I now just need to get my 6 consecutive appointments to qualify for surgery with my insurance. So now I'm just waiting......I have my 6th appointment on July 2 and Pre-op consult with surgeon on july 10. It's not quite may so now is the waiting game. It's been up and downs with keeping weight trying to lose weight losing a little. This is a constant emotional and physical battle. I can't wait to get the sleeve done and then focus on just losing the weight and not worrying about being a certain BMI for insurance and for documentation. Has anyone else struggled with this insurance company?

[ShrinkingPeach 1,291]

Haven't struggled with BC/BS but will definitely say that it seemed to take forever and now its going fast. Take this time to prepare and be ready. Hang in there it will be here before you know it!

[Sharon1964 2,530]

I don't consider it a battle. My insurance company told me what they needed to approve the surgery, and that's what I'm doing. If they came back and changed their requirements, THEN they would have a battle on their hands!

[newrose2427 30]

I have BCBS and the requirements were the same as yours. But what no one told me is, at your last appointment, that's when they file for your surgery to insurance. And they can take up to 2 weeks for them to approve it. My Dr only did surgeries on certain days, so by the time it was approved, I had to wait another whole month!! Frustrating!! Not to say that's what is going to happen with you, just be prepared for "surprises".

[miller1109 116]

I was approved (after all my requirements) within 24 hours. Surgery was scheduled the Next week. I have BCBS of Michigan. It may deond on what state you live in. And I lost 60 pounds before surgery. My surgeon reported my starting BMI not the one after the six months. So even though I was below the required insurance requirement it didn't matter because they don't use that one. Which BCBS do you have?

[HopeandAgony 566]

I am almost at my 4th consecutive appointment I need with my Primary. It has felt like forever to get to this point. I have got through the entire program of dieticians and Psychologist and Physical therapists and seminars and support group. I now just need to get my 6 consecutive appointments to qualify for surgery with my insurance. So now I'm just waiting......I have my 6th appointment on July 2 and Pre-op consult with surgeon on july 10. It's not quite may so now is the waiting game. It's been up and downs with keeping weight trying to lose weight losing a little. This is a constant emotional and physical battle. I can't wait to get the sleeve done and then focus on just losing the weight and not worrying about being a certain BMI for insurance and for documentation. Has anyone else struggled with this insurance company?

Hi! I have BCBS too. I have to do 3 months (4 appts total, lose 6 lbs, and keep a food log). My 4th and final appt will be mid July so we should be looking at about the same time!! I am 37. 255 lbs, and 5'4". I am frustrated with the waiting period but it's allowing me so much time to research. I read and read and read. Have you lost any weight yet? I haven't but I am on a no exercise recommendation until I get clearance from a hip xray I just had done. Horrible hip pain (which is what pushed me to ask for the surgery). We can keep each other company while we wait if you'd like!

[kanknrysmom1 3]

Awesome I'd love that! I really want my surgery in July because I will be off work! Crossing my fingers

[HopeandAgony 566]

I would love it in July to but I think when it's all said and done mine will probably be in early August. I don't know how long it'll take from referral to surgery date so I am trying to be realistic. I have been trying to eat slower and smaller amounts. I have not seen any results yet but it'll all be worth it. Every little bit will help.

Edited April 28, 2015 by HopeandAgony

[NikkiDoc 312]

My BC/BS required 6 months of supervised diet. I didn't need to actually lose any particular weight. I also needed a psych visit. I don't think that 6 months of a supervised diet and the psych visit is a bad thing. It gave me time to start changing eating habits, it gave me time for research. Once the surgeon's office submitted the paperwork to BC/BS on a Tues they had approval by Friday morning.

I had additional testing that the doctor required before I could schedule the surgery- lab work, EKG, upper GI, endoscopy. I was not happy with his office staff since magically 4 different places I had to follow-up with to get the surgeon's office the results. Since the common denominator was the surgeon I think I know where the issue really was. That actually took longer for the surgeon approval of the pre-op testing versus the BCBS approval.

[Smokinjoe781 4]

I hadi sleep abnea

[Smokinjoe781 4]

What I meant to say I had sleep abnea,diabetes, b/c,b/s approved it in two weeks

Edited April 29, 2015 by Smokinjoe781

[nerkerle 18]

BMI 40.3, no other health complications, got approved with BCBS of IL if 3 business days.

[ShellMilliner 233]

It is amazing how different carriers of BCBS differ greatly. I have BCBS of IL and I had a BMI of 50.2. They only required the psych eval, meeting with the NUT, EKG, ultrasound and blood work. It took about 2-2.5 weeks for approval.

[HopeandAgony 566]

I have IL as well. I am starting to wonder if these requirements are due to H. M. O. coverage......

Edited April 29, 2015 by HopeandAgony

[ShellMilliner 233]

@HopeandAgony We have the EPPO so I bet that might be part of it.