BCBS RI requirements?


57 posts in this topic

Hi all,

I am just beginning my exploration into bariatric surgery, and am trying to figure out the insurance logistics of it all. The BCBS RI website isn't very helpful besides to say the surgery is covered after my deductible. Does anyone know if they have the 6 month nutrition requirement? I have seen people from other states say the requirement has been removed from their BCBS, but nothing for RI. Also, what about all the preliminary tests and appointments? Are copays due for all those visits? I plan to go through Miriam hospital if I decide to do it. My initial consultation isn't until November and I am trying to research as much as I can before then.

Subaru likes this 1 Like this

Share this post


Link to post
Share on other sites

You can call your insurance company and they can direct you. I have BCBS Highmark, I called my insurance and they sent me a Copy of the requirements, it didn't say anything about six months requirement. I have payed co-pay for almost all my pre surgery visits with Nut, surgeon, cardiologist, psych and physical therapy. I started my journey late august, I have my psych appointment on Tuesday after which my surgeon will submit documents for approval from BCBS.


Share this post


Link to post
Share on other sites

I have BCBS PPO. When I've called they've said that my only requirement is the doctor to send over the pre-authorization request. I've called twice and spoken with 2 different people. I suspect that they have requirements for the drs office to include specific information and I'm being sent for a psych eval and to the NUT. The surgeon's office said they've never dealt with an insurance company that doesn't have any requirements. (I'm also going through the Miriam program.) As near as I can tell there is no 6 month nut requirement though.

The Miriam program does require attendance at two pre-op support group meetings (minimum). I'm guessing they also require the psych and the NUT because I'm scheduled for those. And then they do additional testing after they get approval. (In my case I will not need a sleep study because I sent them results of one from last year. No endo because they have results from one and seem to prefer upper GI/barium swallow test.)

Not all of Miriam's surgeons do things exactly the same way though. Dr. Ryder requires you to attend an in person orientation where all the other surgeons accept the online orientation.

Share this post


Link to post
Share on other sites
I have BCBS PPO. When I've called they've said that my only requirement is the doctor to send over the pre-authorization request. I've called twice and spoken with 2 different people. I suspect that they have requirements for the drs office to include specific information and I'm being sent for a psych eval and to the NUT. The surgeon's office said they've never dealt with an insurance company that doesn't have any requirements. (I'm also going through the Miriam program.) As near as I can tell there is no 6 month nut requirement though.
The Miriam program does require attendance at two pre-op support group meetings (minimum). I'm guessing they also require the psych and the NUT because I'm scheduled for those. And then they do additional testing after they get approval. (In my case I will not need a sleep study because I sent them results of one from last year. No endo because they have results from one and seem to prefer upper GI/barium swallow test.)
Not all of Miriam's surgeons do things exactly the same way though. Dr. Ryder requires you to attend an in person orientation where all the other surgeons accept the online orientation.


Hey hun I am in the same exact boat on have BCBS of NC and it's also a PPO. I was told they recently changed the stipulations for the better on our end which means you no longer have to do 12 months. I had my initial consult 9/28 was given a pre cert form for my medical doctor to fill out and a list of labs and test. I was also given my appointment for the NUT and my psych eval. I go back to the surgeons office Thursday. My appointment to see the psych is in November and I also go back to the NUT in November.

Share this post


Link to post
Share on other sites
On 10/14/2017 at 8:50 AM, BeTrue83 said:


Hey hun I am in the same exact boat on have BCBS of NC and it's also a PPO. I was told they recently changed the stipulations for the better on our end which means you no longer have to do 12 months. I had my initial consult 9/28 was given a pre cert form for my medical doctor to fill out and a list of labs and test. I was also given my appointment for the NUT and my psych eval. I go back to the surgeons office Thursday. My appointment to see the psych is in November and I also go back to the NUT in November.

Have they given you any sense of other requirements or how long you'll have to visit the NUT? I was able to complete my psych eval in two back-to-back sessions (allowed by this insurance plan but not all I gather). I also had some homework that I dropped off the next day. The Dr. is writing my report and I'll meet with him in 2 weeks to review but then I'm done with him. At the time of my in-person visit he didn't see anything to that point to stop me from being approved. My NUT visit is in two weeks. My surgeon said after they have both signed off they submit to my insurance and then after that approval it's about a month to surgery date, with other assorted tests in between.

I'm hoping for a January-ish surgery date. The surgeon told me it's usually a 6 month process but given how motivated I seemed to be (based on all the documentation I already had sent to him prior to my appointment) he thought January was a reasonable goal.

Share this post


Link to post
Share on other sites
Have they given you any sense of other requirements or how long you'll have to visit the NUT? I was able to complete my psych eval in two back-to-back sessions (allowed by this insurance plan but not all I gather). I also had some homework that I dropped off the next day. The Dr. is writing my report and I'll meet with him in 2 weeks to review but then I'm done with him. At the time of my in-person visit he didn't see anything to that point to stop me from being approved. My NUT visit is in two weeks. My surgeon said after they have both signed off they submit to my insurance and then after that approval it's about a month to surgery date, with other assorted tests in between.
I'm hoping for a January-ish surgery date. The surgeon told me it's usually a 6 month process but given how motivated I seemed to be (based on all the documentation I already had sent to him prior to my appointment) he thought January was a reasonable goal.

That is awesome!!! It sounds like you are on top of things. I am hoping for January date but I am not sure I will have more info for you on Thursday.. Any other questions you would like me to ask when I go Thursday just let me know

Sent from my VS990 using BariatricPal mobile app

Share this post


Link to post
Share on other sites
5 minutes ago, BeTrue83 said:


That is awesome!!! It sounds like you are on top of things. I am hoping for January date but I am not sure I will have more info for you on Thursday.. Any other questions you would like me to ask when I go Thursday just let me know

Sent from my VS990 using BariatricPal mobile app

Nothing in particular, but I'll be interested to hear how it goes. Best of luck!

Share this post


Link to post
Share on other sites
2 hours ago, Subaru said:

Have they given you any sense of other requirements or how long you'll have to visit the NUT? I was able to complete my psych eval in two back-to-back sessions (allowed by this insurance plan but not all I gather). I also had some homework that I dropped off the next day. The Dr. is writing my report and I'll meet with him in 2 weeks to review but then I'm done with him. At the time of my in-person visit he didn't see anything to that point to stop me from being approved. My NUT visit is in two weeks. My surgeon said after they have both signed off they submit to my insurance and then after that approval it's about a month to surgery date, with other assorted tests in between.

I'm hoping for a January-ish surgery date. The surgeon told me it's usually a 6 month process but given how motivated I seemed to be (based on all the documentation I already had sent to him prior to my appointment) he thought January was a reasonable goal.

I see you're in RI, what hospital/surgeon are you using? I am still struggling to decide if surgery is the right option for me. It's a scary step, and I wish I could do it without surgery...but I am afraid I can not.

Subaru likes this 1 Like this

Share this post


Link to post
Share on other sites
1 hour ago, ItsMyTime1985 said:

I see you're in RI, what hospital/surgeon are you using? I am still struggling to decide if surgery is the right option for me. It's a scary step, and I wish I could do it without surgery...but I am afraid I can not.

I'm going through The Miriam Hospital's Bariatric program. My surgeon will be Dr. Todd Stafford. I didn't choose him. When you do the online orientation and request a consult they schedule you with someone. He seems very nice! As near as I can tell, the program and Miriam and at Roger Williams are both pretty good but I have an old hatred for Roger Williams. The Miriam has monthly support groups for pre-op patients (that go toward the required visits) so you might want to check that out. It's a touch decision for sure. Good luck!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now

  • Recently Browsing   0 members

    No registered users viewing this page.