BCBS- TN

[BrittneyMarie 47]

The hospital charged right at $30,000 for just my surgery and there were additional fees for the surgeon, anesthesiology, etc. my insurance knocked it done to half. If I had paid cash, I'd of been given the exact same half price.

[KristenLe 5,980]

The hospital charged right at $30,000 for just my surgery and there were additional fees for the surgeon, anesthesiology, etc. my insurance knocked it done to half. If I had paid cash, I'd of been given the exact same half price.

That is crazy!!! Why bother having insurance at that amount?!

[BrittneyMarie 47]

My thoughts exactly ????

[LRHillian 5]

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

I am just beginning this wls journey. I have BCBST and my surgeon told me I have to lose 10% of my body weight....but as I read the requirements online, it says I have to show failure to lose or maintain the 10% weight loss with conservative means.

Did you lose the 10%? Were you approved for surgery?

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[BrittneyMarie 47]

After my surgeons office did some examining and reexamining, they realized I did not have to lose the 10% of my body weight to have the surgery. The requirement is failure to lose 10%.

I was approved for surgery quickly after I submitted my paperwork (after being denied for not doing my nutrition classes through my primary Doctor and then appealing). Just make sure you have proof of all other requirements. Good luck!!

Also, find out what your hospital will charge. If it's the same situation as me, BCBS-TN only covers half of that amount. I was covered with the highest insurance plan they offer.

[LRHillian 5]

After my surgeons office did some examining and reexamining, they realized I did not have to lose the 10% of my body weight to have the surgery. The requirement is failure to lose 10%.

I was approved for surgery quickly after I submitted my paperwork (after being denied for not doing my nutrition classes through my primary Doctor and then appealing). Just make sure you have proof of all other requirements. Good luck!!

Also, find out what your hospital will charge. If it's the same situation as me, BCBS-TN only covers half of that amount. I was covered with the highest insurance plan they offer.

That was another question...I have started nutrition classes with a weight loss clinic.

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[LRHillian 5]

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

I am just beginning this wls journey. I have BCBST and my surgeon told me I have to lose 10% of my body weight....but as I read the requirements online, it says I have to show failure to lose or maintain the 10% weight loss with conservative means.

Did you lose the 10%? Were you approved for surgery?

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And yes it does say failure to lose or maintain 10% of your body weight. I did question that and both the MD office and the insurance company talked as if I was crazy....

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[BrittneyMarie 47]

I would just hate for the insurance company to deny you because you were able to show you could lose the 10% on your own.

[LRHillian 5]

I would just hate for the insurance company to deny you because you were able to show you could lose the 10% on your own.

I agree....if I could lose 30 pounds. I could continue to lose on my own. So I'm going to try...but not try as hard...maybe 10 or 15 pounds.

What about the nutrition classes? Do these have to be with my PCP?

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[BrittneyMarie 47]

In my paperwork it said I had to do my nutrition visits with my pcp. It was an issue when my pcp didn't have documentation of me questioning weight loss methods and nutrition.

[LRHillian 5]

After my surgeons office did some examining and reexamining, they realized I did not have to lose the 10% of my body weight to have the surgery. The requirement is failure to lose 10%.

I was approved for surgery quickly after I submitted my paperwork (after being denied for not doing my nutrition classes through my primary Doctor and then appealing). Just make sure you have proof of all other requirements. Good luck!!

Also, find out what your hospital will charge. If it's the same situation as me, BCBS-TN only covers half of that amount. I was covered with the highest insurance plan they offer.

I started nutrition classes with a weight loss clinic. I can't get in to see my PCP until June which will push me back a month.

How about the 5 years of weights. I have a new PCP...should I request weights from other doctors? Never had a PCP.

The financial counselor told me I had to pay 868.00 before my surgery.

My psych eval is 475...without bcbst and 585 dollars....with bcbst...

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[hcamille 6]

I am just starting the process and my bcbst did not say that the weight loss had to be supervised just that it had to be over 6 months within the last 2 years. I have that, but I'm curious if your documentation specifically stated medically supervised or not? I think the wording on the diet plan is pretty vague. I seriously cannot imagine trying to loose weight for 6 months it will feel like forever.

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Edited June 20, 2016 by hcamille

[LRHillian 5]

I am just starting the process and my bcbst did not say that the weight loss had to be supervised just that it had to be over 6 months within the last 2 years. I have that, but I'm curious if your documentation specifically stated medically supervised or not? I think the wording on the diet plan is pretty vague. I seriously cannot imagine trying to loose weight for 6 months it will feel like forever.

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Yes. Mine states medically supervised and it has to be with my PCP..

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[reree6898 1,164]

I am just starting the process and my bcbst did not say that the weight loss had to be supervised just that it had to be over 6 months within the last 2 years. I have that, but I'm curious if your documentation specifically stated medically supervised or not? I think the wording on the diet plan is pretty vague. I seriously cannot imagine trying to loose weight for 6 months it will feel like forever.

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Mine with BCBSTN had to be supervised and documented by my PCP monthly.

[hcamille 6]

I am just starting the process and my bcbst did not say that the weight loss had to be supervised just that it had to be over 6 months within the last 2 years. I have that, but I'm curious if your documentation specifically stated medically supervised or not? I think the wording on the diet plan is pretty vague. I seriously cannot imagine trying to loose weight for 6 months it will feel like forever.

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Mine with BCBSTN had to be supervised and documented by my PCP monthly.

Thanks, mine does not state medically supervised and I found someone else with a similar plan who didn't have to be medically supervised either. I just wanted to be certain.

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