Insurance Says NO! BSCA

[nennas_mommy 20]

My co-worker just got the gastric sleeve done on July 9th. We obviously work for the same company and we have the same insurance, same plan, everything. Well, I recently went to the same seminar she did, at the same hospital she went to and today I got a call from the coordinator saying that my insurance does not cover Bariatric surgery!! What the heck is going on!!?? So I called them myself and the representative gave me a "yes and no" type answer. He said I'd have to go through 6 months of medically supervised weight loss, a psychological evaluation, so on and so forth. All of which is done at the hospital where I went to the seminar! I am just confused.

Sent from my iPhone

[KristenLe 5,980]

My co-worker just got the gastric sleeve done on July 9th. We obviously work for the same company and we have the same insurance, same plan, everything. Well, I recently went to the same seminar she did, at the same hospital she went to and today I got a call from the coordinator saying that my insurance does not cover Bariatric surgery!! What the heck is going on!!?? So I called them myself and the representative gave me a "yes and no" type answer. He said I'd have to go through 6 months of medically supervised weight loss, a psychological evaluation, so on and so forth. All of which is done at the hospital where I went to the seminar! I am just confused.

Sent from my iPhone

Does your BMI meet requirements? Your insurance coordinator may have been given wrong info - that seems common with BC. I would ask for a printout of coverage and give to coordinator .

Sent from my KFFOWI using the BariatricPal App

[nennas_mommy 20]

Yes. My BMI is 43! The minimum is 40. She was told that neither the HMO or PPO plans covered Bariatric services at all! I gave her my call reference number and She said she'd call again tomorrow so finger crossed!

Sent from my iPhone

[Going2lose 9]

I had trouble with my Blue Shield of CA and asked to speak to a manager and then they confirmed what I have already found online...only need to meet BMI requirement, psych eval and a suggested 3 month waiting period. I was approved twice (changed doctors) without waiting 3 months. Good luck!

[sc101071 398]

Sounds like you are covered. I got lots of different answers when I was trying to figure out the requirements of my insurance for approval. I'd ask for a copy of your plan. Might be able to get it from your HR dept.

[heathero78 18]

Might be an exclusion or required to have co morbidities. Coworker might have also had dual coverage insurance or other health issues.

Sent from my XT1585 using the BariatricPal App

[lessismore4me 47]

I ended up paying for mine with a medical loan because I had waited so long trying to get my insurance to pay for mine. First I had to wait five years at my job to be eligible, then I had to participate in 12 months of supervised diet and prove I had two co-morbidities. It ended up being cheaper doing private pay, than using my insurance. So it made no sense to keep waiting. I bit the bullet and got the loan. I am so happy I did.

Sent from my SM-G925V using the BariatricPal App

[nennas_mommy 20]

Oh my goodness! 5 years! Then 12 months! Mine only requires a 6 months supervised weightless.

[Destinee_1 16]

I accidentally went to a seminar for patient with BSCA and other insurance in another county only to find out they didn't take my insurance from my county. I could have had the surgery within 4month. However I had go through my PCP and get a referral to doc my insurance covered and jump through those hoops. Every step of the way has been worth it so far and took about 11months. I wanted to go to Florida first so I waited an extra 2 months lol.

[Jesm1029 101]

I have bcbs im in ct i did the 6 month nut and evaluation and my insurance approved

Sent from my SM-G935T using the BariatricPal App

[Minz 4]

I have blue shield ca HMO and bariatric surgery is excluded and my Dr submitted a referral since I have high blood pressure and bmi of 42, this makes it medically necessary, no issues at all, once submitted I was approved in 5 days. Only had to see a psychologist, no diets. My surgery is scheduled 8/18. It must be the bariatric surgery Dr office that isnt submitting the paperwork correctly. Try again

Sent from my SM-G930T using the BariatricPal App

[slimbrick 0]

I have Aetna. My bariatric coordinator told me it wasn't covered, but my wife who has same insurance had the surgery a year before. Turns out the hospital wasn't an "institute of excellence". All that means that instead of insurance covering 90%, they covered 80%. It was obviously well worth doing it for the extra percentage, but if you don't know the right questions to ask insurance you won't get the right answer!

Sent from my iPhone using the BariatricPal App