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Approvals with BCBS Federal

rln52

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Abby&IvysMom    22

Abby&IvysMom
Posted

I was approved BCBS ( AHC) doing my endoscopy Thursday, EKG etc also on Thursday, then to regular MD for letter of need. Has anyone every had a problem getting this letter from their regular MD? Anyone here from N.C.??

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PlBren    21

PlBren
Posted

I have BMI of 38.8 and was approved. I have hypertension and arthritis which approved me.

Interesting. I too have arthritis - two knee replacements. And was told that is nothing the insurance would consider.

I don't understand how one insurance co can appear to be so different based on the Surgeon you chose. Frustrating!

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SleeveandRNYchica    1,155

SleeveandRNYchica
Posted

I just heard back from my insurance coordinator everything is finished. I just have 1 more weigh in. Early September. She said it takes 10-14 days for approval. I hope to have the choice between two Blue Distinction centers. So I am thinking I may be scheduled before end of Sept!

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nomoremeds    27

nomoremeds
Posted

Great news. Progress!

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SleeveandRNYchica    1,155

SleeveandRNYchica
Posted

Great news. Progress!

Thank you! It is!! So I can do my last weigh in by video.

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babbs2299    15

babbs2299
Posted

Congrats SleevenChica!! Hopefully I'll be about 1 month behind you!

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SleeveandRNYchica    1,155

SleeveandRNYchica
Posted

Congrats SleevenChica!! Hopefully I'll be about 1 month behind you!

Keep me posted!!!

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PlBren    21

PlBren
Posted

Today is day 12 for me since my paperwork was submitted and still no word. Though according to customer service at BCBS, they don't have any record of any paperwork at all. But the insurance coordinator tells me to ignore them- that they don't know what is going on. So - who to believe?

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SleeveandRNYchica    1,155

SleeveandRNYchica
Posted

Today is day 12 for me since my paperwork was submitted and still no word. Though according to customer service at BCBS, they don't have any record of any paperwork at all. But the insurance coordinator tells me to ignore them- that they don't know what is going on. So - who to believe?[/quote

That is beyond frustrating? Did you call the main number or the number on the back of card for preauthorization? I find in odd BCBS had no record of your paperwork.

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scoutmom    63

scoutmom
Posted

@

I, too, called BCBS to check on my status and was told it wasn't received or in the system.....not ten minutes later, my coordinator called with an approval code. My experience was that the 'system' takes several days after approval to be entered. So don't be surprised if you call and they say that haven't received. At least that is exactly what happened with me. Your insurance coordinator drives the train!

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PlBren    21

PlBren
Posted

@

I, too, called BCBS to check on my status and was told it wasn't received or in the system.....not ten minutes later, my coordinator called with an approval code. My experience was that the 'system' takes several days after approval to be entered. So don't be surprised if you call and they say that haven't received. At least that is exactly what happened with me. Your insurance coordinator drives the train!

Good to know Scoutmom - that makes me feel much better. Still - it will be two weeks on Monday and my insurance coordinator told me that BCBS is the quickest and they always here between 3 days and 2 weeks. I worry that denials take more time and thus I'll be getting bad news. Has anyone been denied by BCBS and then accepted on appeal?

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SleeveandRNYchica    1,155

SleeveandRNYchica
Posted

My insurance coordinator said 10-14 days.... It is interesting maybe she is being conservative....

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PlBren    21

PlBren
Posted

  • I just got approved!!! But I have to wait until tomorrow to get my surgery date. Here are my stat's -

History of over 35 BMI for 2+ years

Moderate sleep Apnea

Hiatal Hernia

Arthritis in both knees (though my Dr. said they don't consider this)

Current BMI of 38 (started at 39 before I did my three month weight loss consulting).

So happy, it is in site. Starting my liquid diet today just in case I can get the surgery date of Sept 1st.

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SleeveandRNYchica    1,155

SleeveandRNYchica
Posted

  • I just got approved!!! But I have to wait until tomorrow to get my surgery date. Here are my stat's -
History of over 35 BMI for 2+ years

Moderate sleep Apnea

Hiatal Hernia

Arthritis in both knees (though my Dr. said they don't consider this)

Current BMI of 38 (started at 39 before I did my three month weight loss consulting).

So happy, it is in site. Starting my liquid diet today just in case I can get the surgery date of Sept 1st.

2 weeks exactly! So happy for you!

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SleeveandRNYchica    1,155

SleeveandRNYchica
Posted

So @@scoutmom was absolutely correct all this time they said they didn't have it but now u at approved! So good to know!

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • KeeWee

      KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
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    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
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    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
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    • ChunkCat

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      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
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