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.

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[KristenLe 5,979]

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.

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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 .

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[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!

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[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.

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[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.

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[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

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[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

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[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!

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