Insurance Approval Jitters

[doingitmyway 87]

Thanks. I'm worried and nervous. My provider will call on Wednesday to check the status. I guess I just need to trust that my bariatric office are seasoned at this process. They know what it takes and if they thought it was impossible, they wouldn't waste their time either. Praying it goes smooth

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[Amurillo04 109]

I'm in the same boat I just submitted my paperwork to my coordinator via email Friday at 7PM but she leaves at 5pm so she didn't receive it. I'm hoping she gets back to me today to at least let me know she received it.

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[doingitmyway 87]

Do you mind me asking your BMI and if you have any weight related issues?

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[Amurillo04 109]

My first appointment I had a bmi of 41. Now I am at 39, my surgeon made it very clear he wants me to lose some weight and told me that it's only the first weight that counts and I do not have any weight related issues.

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[donya4859 28]

Just got my approval today so excited to move on to the next steps of this process.

[Amurillo04 109]

Just got my approval today so excited to move on to the next steps of this process.

Congratulations!

[Kyn13 215]

Grrrrrrr! !! I'm really starting to hate the woman I'm supposed to get a hold of at my surgeon office... she is never there... and when she is she never returns my phone calls!!! Called at 830 this am left a vm, called just now at 140 and she is gone for the daum day.

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[Amurillo04 109]

Grrrrrrr! !! I'm really starting to hate the woman I'm supposed to get a hold of at my surgeon office... she is never there... and when she is she never returns my phone calls!!! Called at 830 this am left a vm, called just now at 140 and she is gone for the daum day.

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My coordinator is like that too. I can only get a word with her through email and sometimes she doesn't even answer me. It's super annoying but I just try to tell myself I'm not the only one she's dealing with /:

[doingitmyway 87]

@@doingitmyway If your BMI is over 35 but under 40 it really depends on the seriousness of the hypertension......sometimes if it's controlled with one medication it's not approved......if you have to take more than one medication it's more likely to be approved............Is hypertension the only obesity related condition you have?.....If it's denied try not to worry too much....ask your surgeon to do a peer to peer review.....he obviously thinks you need to surgery, so he can argue your case with a Florida Blue doctor and may be able to get it approved for you.

Wishing you the best of luck!

Kathy

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[pansy27 23]

I am in the process right now and I'm scared.. I have hypertension but not on max doses of my two meds.. But I've been on them for almost 7 yrs.. But bcbs of NC states must be on max doses.. I have no other comorbidities... I do have horrible osteoarthritis which is a comorbidity but I had my knees replaced last year at 44.. I've asked my orthopedic Dr to write a letter stating rhetoric advantage of losing significant weight for my new knees to last.. Right now I'm at 38.7 bmi.. They stated they would submit the first weight the day of the orientation and the second weight the day of surgery.. I'm like 7 lbs from 40 bmi and then I wouldn't need any comorbidity.. I'm so scared I'll go through all this for nothing but when I went to orientation they said that if the pa did not feel you had a chance at approval she would not let you attend the Class..but the coordinator told me that without being on max doses of BP meds bcbs will deny.. But they are getting my records from my ortho too.. And of course I suffer from fibro which losing weight would help that pain so much

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[doingitmyway 87]

@@doingitmyway If your BMI is over 35 but under 40 it really depends on the seriousness of the hypertension......sometimes if it's controlled with one medication it's not approved......if you have to take more than one medication it's more likely to be approved............Is hypertension the only obesity related condition you have?.....If it's denied try not to worry too much....ask your surgeon to do a peer to peer review.....he obviously thinks you need to surgery, so he can argue your case with a Florida Blue doctor and may be able to get it approved for you.

Wishing you the best of luck!

Kathy

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Do you suggest or advise against talking to a case manager at BCBS

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[kmorri 1,689]

@@doingitmyway If you've been offered a case manager they could be a big help to you. I would suggest doing that for sure! They will also be able to keep you up to date on the status of your authorization for surgery.

[doingitmyway 87]

I just called. I was told that state employees Florida BCBS does not require prior authorization. Only documentation of meeting the plan requirements. The rep said this could even be submitted with the claim at time of service.

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[donya4859 28]

Thanks @ Aumurillo04

[kmorri 1,689]

I just called. I was told that state employees Florida BCBS does not require prior authorization. Only documentation of meeting the plan requirements. The rep said this could even be submitted with the claim at time of service.

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That's not correct....you do need the authorization for the surgery to be approved prior to surgery.....All I can think is maybe there was a misunderstanding in terminology.....but bariatric surgery requires pre-authorization.....Not only did I work there for 29 years my personal insurance is also Florida State Employee...so I have the same plan as you. :-) Especially since your BMI is less than 40.....You certainly don't want to take a chance of it being denied after the surgery is already been done....then you would be stuck with the bill. I suggest you call back and make sure they understand you're talking about Gastric Sleeve............and if I understand correctly you said your provider's office already submitted the authorization request, right? If they have already submitted it, what you should be asking is what is the status of that auth request.....They are closed now, but you can call them back tomorrow.