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BCBS of Alabama

I have BCBS of Alabama and I was denied because I do not have 2013 medical records. I was told to send in pictures. I have read their surgery manuel for obesity and it said something about getting a letter from your PCP. Everything is double underline so I'm not sure what this means. Have anymore had to send in picture documentations and did you have to send in a letter, too? The PCP is the one who referred me to this surgeon and he has already sent in documentation the first time.

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I have BCBS of Alabama to and have had to go to all the Dr's ( ie urgent cares and walkin clinics ) if my PCP wasnt available and that was good so far for my surgeon and have 1 more visit to my PCP on the 25th .Then go meet with the surgeons office and go from there .The lady in the office said pictures would do as well and the should dated but if not write a letter stating when they were taken that's what she told me .good luck

  • Author

Do you have 3 years of medical records?

I didnt at first but then remembered I had went to a couple of urgent cares and went back to them and asked for my records and they had all my vitals on it including my weight and my ob/gyn was also good enough from what my Surgeons office said .

  • 2 weeks later...

I don't have medical records but I have pictures and my surgeon said that they should be sufficient. I also have Bc/Bs of Al. Have they approved you yet?

Who is your surgeon if you dont mind me asking?

  • Author

I have not been approved because the office administration is not helpful at all. When I tried calling about paperwork to see if the items had come in, she would make nasty comments. Then, they would say they had problems with pictures in the past. They are no help at all. When, I talk with respresentatives at BCBS they say read the manuel. I've read the manuel over and over again and still can't get clarification. So, now I'm trying to see with my PCP will write a letter to go along with the pictures. If she doesn't, then I will just have the surgeon's office to send in the pictures. I'm really lost and this point.

  • 2 weeks later...

Sorry to hear that I was just denied due to BCBS AL hold me haveing pneumonia in 2013 where my BMI dropped to 28.1 but I was not eating because I was sick so now my surgeon office is writing a letter to see if that will be approved if not I will have to wait a year to try again ,I have mentally prepared myself along with my husband for this day just to get bad news I have a yo-yo affect with my body and I wanted to prevent future issues you would think they would benefit from that and not having to pay for unessary Dr visits in the future .

Sent from my XT1254 using the BariatricPal App

  • Author

Do you know how many times you can reapply?

They said they were putting in a written request then I would half to do it all over again with the six month thing and then would have to wait till next Feb I was not happy needless to say

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I have AL BC/BS. I was denied. My sleep apnea wasn't bad enough. SO, I paid for my surgery with a loan and using my medical spending account. It was much easier than jumping through so many damn hoops. My BMI wasn't high enough for BC/BS. I didn't want to get any bigger and wait another two years.

I shopped around for a cheaper cash price surgeon and found one where I live (Huntsville). Dr. Suggs is his name if you're in North Alabama. it was $9800 for everything (anesthesia, hospital stay and doctor's fee).

  • Author

Thanks because I keep getting the run around. Each time I called the insurance company they tell me to read the manuel. I have read the thing a million times and called. I am just trying to get clarification, which is: do I just send in pictures or pictures and a statement from PCP. Once again, they say read the manuel. I am thinking about asking for another referral or giving up. This is a mess! I guess I will have to save up and pay for the surgery because I have written my PCP asking for a letter to accomplish the pictures and no such luck.

You should be fine with having your primary care doctor submitting the photographs. Make sure they are dated! post-33507-1486110607744_thumb.jpg

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