Newbie with lots of insurance related questions!

[lisamarie8308 0]

Hi everyone! I am in the beginning stages of the process towards the gastric sleeve surgery, and my seminar is on Thursday. I live in FL, but have BCBS NC through my husband's work. I just got off the phone with their customer service and am very confused, so I am hoping you all can help me!

I have been doing reading online about their requirements for coverage, and I know that BCBS NC just changed their policy to reflect " documentation of 12 consecutive months of active engagement in weight related treatment, as described above. Judgement regarding the scope, depth, and adequacy of pre-surgical treatment during the 12 months prior to surgery is at the discretion of the multidisciplinary weight loss surgery team, and BCBSNC does not specify the content of the treatment."

The lady that I spoke to on the phone said the only requirement was this documentation of 12 months, and when I asked her about the psychological evaluation or the meeting with the nutritionist, she said that those are not showing as required. However, when I check their website, this document states that they ARE required. https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/surgery_for_morbid_obesity.pdf

Now here are my questions:

I have been seeing my PCP off and on since 2013 (did not go when I with between jobs and did not have insurance). I went back to her in June or July of 2016, and have bee going consistently since then. She has documents of my weight from 2013 on, has been working with my on my weight since then, and put in the referral for me to my bariatric surgeon. She is 100% in support of me having the surgery done as soon as possible. I told the rep from BCBS that I don't see my PCP every month, but she didn't know if that would be a problem or not. Thoughts?

Is the approval process for BCBS NC difficult? And how long does it typically take?

And last question: Is the surgical center helpful in this process? This insurance stuff is super overwhelming!!

Thanks so much!

Lisa

[hotmamma1979 42]

I can answer the last question, the Bariatric program is usually very helpful as this is all they do! They check exactly what needs to be done and they'll tell you. It's a win win for everyone involved so they are good about checking on it.

[KrisZ 23]

Also ask for help with insurance from your surgeon's staff. They are the ones that deal with the billing and such and know what I'd required with the different insurance companies.

[boltsgirl1012 10]

I'd trust what you see on the website over what someone told you. It'd be RARE for them not to require the psych eval. If it says consecutive months, it means consecutive months. You may want to consider doing your consecutive months with your surgeon. That's what I'm doing, and it's going to give me that much more time to get comfortable with him, and for him to get to know me and my habits. I have United Health personally, so can't speak for BCBS approval process, but if you work with your surgeon, he should be able to help with everything!