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BCBS- TN

BrittneyMarie

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BrittneyMarie    47

BrittneyMarie
Posted

Things I wish I had known about my insurance going into my initial appointment with my surgeon:

1. BCBS TN requires 6 months of nutrition classes ( 1 per month)

2. 1 Psych eval that is good for only one year

3. Your nutrition classes have to be done through a doctor other than your surgeon

4. BCBS TN will deny you if you submit nutrition classes that were done through your surgeons office

5. Your primary physician must have some documentation of you wanting to learn about bariatric surgery and/or nutrition

6. If your BMI is over 40, no proof of premorbitities are necessary, but they can always help your case

7. You don't have to lose 10% of your body weight before submitting applications to your insurance company >:(

  • The insurance department woman working with me initially told me that she couldn't do anything until I lost 10% of my total body weight
  • If I didn't lose 10% of my body weight, proving that I was serious about losing weight, the insurance company would deny me
  • THIS WAS ALL COMPLETELY FALSE!!!
  • Her saying what she did, pushed me back almost a full year

8. If you are denied, file a grievance AND make sure your surgeons office files a grievance too!

I hope this helps someone not have to go through the ups and downs as I did. After a year and a half of trying to get my approval, I finally got it and am scheduled for April 11th!

Good Luck and BIG hugs!

- Brittney

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PJinTenn    0

PJinTenn
Posted

Thanks for sharing!!

I am just starting this process with BCBS of Tenn. When i went to the bariatric surgeon's seminar thing (Vanderbilt) they had all of my insurance info requirements ready for me. Now, I'm trying to get with my primary care doc to help diagnose some of the comorbidities that I've not previously been diagnosed with (since my BMI is just SLIGHTLY under 40). I hope he can help. I've recently been diagnosed with HBP, and last week's blood work showed i have elevated LDL, and i took a 1 hour glucose test, and tested high on it... just to read the fine print from insurance saying it has to be the 2 hour test! So, i'll have to re-take it on Monday at my pcp doc office. if it is still high, then i believe i have my 3 comorbidities that are required. Then to get my pcp to even agree to recommend it....

Then i can go back to the bariatric surgeon with all the "pre-requisites" i need for them to take me on.

Wish me luck!

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reree6898    1,164

reree6898
Posted

I have BCBSTN as well, when I got started I had them email me the requirements so that I had it straight from them in writing just in case. I too went through Vanderbilt, Dr Spann is wonderful. I was done six months ago and right at 100 lbs lost since surgery. Good luck to you both!

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MemphisRN78    0

MemphisRN78
Posted

I have BCBS of TN....for the 6 month medically supervised diet.....does that mean 6 visits or actually 7 (with your PCP). I finished my 6th visit today and eager to submit my paperwork to the bariatric office so they can send it on to the insurance for approval...Any extra details on this would be awesome

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reree6898    1,164

reree6898
Posted

They told me that they want six full months of documented weight loss effort so to be sure that there was no way for them to deny me we did a seventh visit because the first visit was day one of the six months.

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BrittneyMarie    47

BrittneyMarie
Posted

I had 6 full nutrition visits, not 7.

Good luck everyone!

Sent from my iPhone using the BariatricPal App

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PJinTenn    0

PJinTenn
Posted

I have BCBS of TN and they required 5 years of a BMI of over 40 or 5 years of a BMi of 35-39 with at least one co morbidity which I didn't have.

Sent from my iPhone using the BariatricPal App

Breezy, one comorbidity which you didn't have.. so how did you get approved? I'm really worried about not being approved

Sent from my SM-G920P using the BariatricPal App

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BrittneyMarie    47

BrittneyMarie
Posted

I had to have 5yrs of weights. I got them from my primary care doctor.

BCBS-TN only paid 50% of my surgery. My price with insurance ended up being the exact same amount if I had paid out of pocket. Looking back now, while I loved my nutrition classes, I wish I had just paid out of pocket and didn't go through all of the insurance hoops.

I would talk with your surgeons office, the hospital, and BCBS-TN to see if you'd end up paying the same amount whether you have insurance coverage or not.

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LRHillian    5

LRHillian
Posted

I had to have 5yrs of weights. I got them from my primary care doctor.

BCBS-TN only paid 50% of my surgery. My price with insurance ended up being the exact same amount if I had paid out of pocket. Looking back now, while I loved my nutrition classes, I wish I had just paid out of pocket and didn't go through all of the insurance hoops.

I would talk with your surgeons office, the hospital, and BCBS-TN to see if you'd end up paying the same amount whether you have insurance coverage or not.

Did you have to pay all before surgery??? If it gets to he to much...I'm going to have surgery in Mexico.

Sent from my SM-G928T using the BariatricPal App

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BrittneyMarie    47

BrittneyMarie
Posted

I had to pay half on the day of surgery.

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