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.

That's fantastic! It's moving along smoothly so far! I see the NUT in two weeks and also go back to the psych to go over that report. Then I don't really know what happens!

Thank you so much... You should be able to meet with the surgeon after that

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12 hours ago, BeTrue83 said:

Thank you so much... You should be able to meet with the surgeon after that

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I did meet with him already. It's not clear to me with my program if I will see him again until just shortly before surgery. I guess I'll find out!

I did meet with him already. It's not clear to me with my program if I will see him again until just shortly before surgery. I guess I'll find out! [emoji3]

O ok hopefully you will know something soon

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On 10/19/2017 at 1:36 PM, Subaru said:

That's fantastic! It's moving along smoothly so far! I see the NUT in two weeks and also go back to the psych to go over that report. Then I don't really know what happens!

Psych clearance today. NUT next week. Onward and upward!

Psych clearance today. NUT next week. Onward and upward!

That is awesome!!!! Thanks for keeping me updated

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Didn't get a chance to read all the replies here so I hope I'm not repetitive, but I'm going through Miriam as well (dr. Stafford) I also have BCBS. I called before starting the process to see requirements, there was no six month observation just the deductible & a referral from a primary (though I was told by surgeon's office process takes 6-9 months). I had my consultation 8/26 and have completed my psych, sleep study (which you can now do from home!), required meetings, & have one class for nutritionist before I'm all set with that then I wait for approval! Once approved I'm told I need to do an ekg, blood work, & swallow test (which can be done in one day at Miriam). You do have to pay your copay for each visit (specialist copay). Hope this helped and good luck to you all! If any of you ri sleevers want to get in touch lmk! [emoji4]

21 minutes ago, briae13 said:

Didn't get a chance to read all the replies here so I hope I'm not repetitive, but I'm going through Miriam as well (dr. Stafford) I also have BCBS. I called before starting the process to see requirements, there was no six month observation just the deductible & a referral from a primary (though I was told by surgeon's office process takes 6-9 months). I had my consultation 8/26 and have completed my psych, sleep study (which you can now do from home!), required meetings, & have one class for nutritionist before I'm all set with that then I wait for approval! Once approved I'm told I need to do an ekg, blood work, & swallow test (which can be done in one day at Miriam). You do have to pay your copay for each visit (specialist copay). Hope this helped and good luck to you all! If any of you ri sleevers want to get in touch lmk!

Thank you so much for the info!! That's a long waiting period! I wonder if it would have helped to have my PCP submit a referral right away. Hmmm. My consultation is next Thursday so I guess I mine as well wait and see what he has to say before I do anything else. Best of luck to you! Keep me posted on how you're making out!

Do you know the name of the Miriam bariatric facebook support group? I heard it mentioned at the support group I went to in September but I forgot the name and tossed the handouts. I joined another facebook group but there is a lot of negativity and it would be nice to connect with people closer to home.

43 minutes ago, briae13 said:

Didn't get a chance to read all the replies here so I hope I'm not repetitive, but I'm going through Miriam as well (dr. Stafford) I also have BCBS. I called before starting the process to see requirements, there was no six month observation just the deductible & a referral from a primary (though I was told by surgeon's office process takes 6-9 months). I had my consultation 8/26 and have completed my psych, sleep study (which you can now do from home!), required meetings, & have one class for nutritionist before I'm all set with that then I wait for approval! Once approved I'm told I need to do an ekg, blood work, & swallow test (which can be done in one day at Miriam). You do have to pay your copay for each visit (specialist copay). Hope this helped and good luck to you all! If any of you ri sleevers want to get in touch lmk!

That's great info! In terms of required meetings, do you mean the group meetings? I don't have to do a sleep study since I've had one in the last year. According to the woman in Dr. Stafford's office, once I get NUT clearance (which I am hoping is just this one visit this week), they will submit to BCBS. Once they get approval they will schedule me for my pre-op with the surgeon (often within the same week as approval). At that visit we will schedule surgery and discuss any other questions/outstanding stuff. Between then and surgery will be the pre-op testing that you referenced, and I have to go to the several hour long pre-op seminar. (Held on Thursdays at 3:30 btw.) From the sound of things, I'm, 6-8 weeks out from surgery.

Dr. Stafford also told me that the process typically takes 6 months. And then he flipped through all of the test results I'd already had sent to him and told me that since it seems I'm on top of things it would like be faster. I told him I was targeting early January and he thought that was very reasonable.

When do you have your NUT appointment? It sounds like we're on a very similar track!

25 minutes ago, ItsMyTime1985 said:

Do you know the name of the Miriam bariatric facebook support group? I heard it mentioned at the support group I went to in September but I forgot the name and tossed the handouts. I joined another facebook group but there is a lot of negativity and it would be nice to connect with people closer to home.

I can't think of the name of it. However, the newsletters are available on the Miriam Bariatric page and they usually list the Facebook group. I think (?) I joined or requested to join but I don't know as I've read that page or posted to it yet. Good luck!

@ItsMyTime1985 it actually has flown by! For a minute I wished it slowed down a bit tbh, but my nerves have settled a bit more and I'm at the point where I just want my date (however far out) so I can plan for the time I'll need off lol it couldn't hurt to have your pcp send a referral ahead of time, though I had my first appointment with a new pcp a few days after my first consultation and there was no issue with getting the referral after. The Facebook group you have to request to join by messaging the coordinator on fb the name is on the newsletter which should be up on the Miriam bariatric site soon. [emoji4]
@Subaru yes the group meetings, I took the online seminar then went to 2 in person meetings. I had 2 appointments with nutritionist (Kim) and then there's a class I'm going to on the 20th (she said it's where they go over what you'll need for surgery) and after the class all my pre op requirements are good and can be submitted for approval. It definitely sounds like we're on the same track! I think the six months is dependent on when you can get the NUT, psych, & sleep study done tbh. I was able to get them done sooner than expected though.

My only question now is what my time frame looks like as far as how long it takes to hear back once it's approved. Anyone know? I'm hoping I can get my surgery date at least a month prior to the day of it in order to set things up with work for time off... [emoji51]

20 minutes ago, briae13 said:

@Subaru yes the group meetings, I took the online seminar then went to 2 in person meetings. I had 2 appointments with nutritionist (Kim) and then there's a class I'm going to on the 20th (she said it's where they go over what you'll need for surgery) and after the class all my pre op requirements are good and can be submitted for approval. It definitely sounds like we're on the same track! I think the six months is dependent on when you can get the NUT, psych, & sleep study done tbh. I was able to get them done sooner than expected though.

My only question now is what my time frame looks like as far as how long it takes to hear back once it's approved. Anyone know? I'm hoping I can get my surgery date at least a month prior to the day of it in order to set things up with work for time off...

Briae13, is your bcbs a PPO or an ***? I’m asking In hopes that you have an *** and that’s why you had to go to the nutritionist several times. I’m hoping I only have to do the one visit. Nobody said anything about a class, but that would make sense. What time of the day is that class on the 20th? If I have to go to one of those classes and I can squeeze getting in on the 20th, I will certainly do it!

In terms of how long insurance approval takes, I have heard that it can take up to three weeks. However, I suspect that if you are proactive in following up with Blue Cross it may push things through more quickly. I’ve certainly read plenty of posts were people said it took a week or even less. I think the three weeks is their outside timeline.

The *** were for “H M O.” For some reason the site masked that.

That is awesome!!!! Thanks for keeping me updated

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Update I had my psych clearance today....all of those freaking questions!!!!

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9 minutes ago, BeTrue83 said:

Update I had my psych clearance today....all of those freaking questions!!!!

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Congrats!!

@BeTrue83 did you have to take the survey thing? So annoying, felt like I had legit just answered allll of the same questions [emoji23]
@Subaru I have a ppo, but I would think 2 would be the minimum. The first visit she asked different questions about how I ate and then gave me "homework" on how to eat differently. Second visit was mostly just checking that I was (mostly) following instructions and see if I made any body composition progress. The class is something the NUT has to schedule you for. I think mine is @12:30 or so? But there was another earlier, there's 2-3 others who attend at the same time. Tbh I kinda wished I had more time with my NUT, it's scary to think I saw her twice and now won't see her again till post op lol

Thank you! That's kind of what I was thinking (2-3 weeks) and I'll certainly be checking with my surgeon's office regularly (should I call insurance company itself though?) also do I pay deductible before approval or after? Lol so new to bcbs