BCBS of TX PPO

[Hotmama@48 9]

Hello everyone! I'm quite new to this forum, and I came across this awesome website, and boy, am I so glad I did! It has been a real help as I am currently in the process of trying to get insurance approval for the Gastrectomy Sleeve. I currently have BCBS of TX PPO insurance, and I received my predetermination letter in the mail saying that the surgery is a covered benefit under my particular plan and would be covered provided that I have met all the requirements needed. So I suppose it's pretty much safe to say that I have been approved for the surgery. I haven't heard back yet from my case manager at my doctor's office, but according to my letter and the phone conversation with the insurance company, they too, would be receiving the same letter. My doctor's office submitted my paperwork to the insurance company on 5/24/16 and they came back with the aforementioned letter dated 5/27/16; so three days to respond. That was quick considering that my case manager said that they could take up to 2 weeks to 30 business days. Anyway I just wanted to share with anyone who may be curious about the approval requirements for BCBS of TX PPO. The requirements that I had to meet were the following:

BMI > 40 or BMI > 35. (mine was 41 & I have HTN as well as sleep apnea)

 Psychiatric Evaluation.

 Sleep Study.

 No diet waiting period! (I was surprised by this)

So, it is possible that not all insurance policies require a diet requirement like many that do. My CM even said that BCBS is one of the few insurance companies that has this. Now I’m just waiting to here what the next step is....I’m getting excited!!!! Anyway I hope this little information may be of help to someone.

Edited June 4, 2016 by Hotmama@48

[Pink Ninja 67]

I also have BCBS of TX! My requirements were similar. They didn't require a sleep study but I needed a letter from my PCP recommending me for surgery based on my worsening medical conditions. My patient advocate submitted my paperwork today and I'm so excited to read yours only took 3 days! He told me it would be 2-3 weeks. Do you have a date for your surgery yet?

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[Deletemyacct 39]

I have bcbs-ca & i called on several occasions & they said the same for my plan, I'm so surprised. I went to a center who told me they had the 6mths diet requirement so i believed them but when i spoke to my insurance directly they didn't have that & said some doctors have their own requirements not the insurance. I was told the procedure is covered for obesity, but I will consult with another doctor & go from there.

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