Jump to content
×
Are you looking for the BariatricPal Store? Go now!

BCBSM Pre-Op Appointments not covered..



Recommended Posts

I have BCBSM PPO and while the surgery is covered, the pre op appointments for the monthly visits with the dietician for the 6 month supervised weight management is not covered.. The BCBSM claims specialists stated it would never be covered because of the code they use to code the reason for the doctor visit which is a weight management code for “morbid obesity due to excess calories”.

Has anyone else run into these problems? Did you just pay for your appointments out of pocket?

Share this post


Link to post
Share on other sites

What a dirty trick for BCBS to pull. I feel,morbid obesity is a disease , not a trivial lifechoice. That's like telling someone with a mental illness to settle down and they'll be healed. I wish those executives,had to walk a mile in our shoes,i've been overweight for most of my adult life, tried diets both fad and structuralized, I can't do it without surgery.I'm sorry if I sound like I am ranting but it isn't fair for a lot of us.

Sent from my VS880PP using BariatricPal mobile app

Share this post


Link to post
Share on other sites

It's all about what's in the plan coverage. Your insurance company should be sending you an annual Schedule of Benefits that explains what is covered and what isn't. They are required to do so at the start of every plan year by the ACA.

I was annoyed that my insurer was not going to pay for the visits to the weight loss clinic they require prior to surgery, but it wasn't a surprise.

Share this post


Link to post
Share on other sites

I work for a BCBS company, sounds like office visits are covered however Obesity is listed as an exclusion on your policy. While your docs billers and coders cannot alter what your docs chart notes say, I’d recommend asking them to change the primary dx code to something other than obesity, that should help your Pre op visits go through, best of luck.

Edited by Dream2018

Share this post


Link to post
Share on other sites

It's all about what's in the plan coverage. Your insurance company should be sending you an annual Schedule of Benefits that explains what is covered and what isn't. They are required to do so at the start of every plan year by the ACA.
I was annoyed that my insurer was not going to pay for the visits to the weight loss clinic they require prior to surgery, but it wasn't a surprise.


I too am annoyed with this. How did you go about scheduling your appointments for the supervised weight loss visits? Out of pocket?


Share this post


Link to post
Share on other sites

On 1/25/2018 at 8:23 AM, genia_deanne said:

I have BCBSM PPO and while the surgery is covered, the pre op appointments for the monthly visits with the dietician for the 6 month supervised weight management is not covered.. The BCBSM claims specialists stated it would never be covered because of the code they use to code the reason for the doctor visit which is a weight management code for “morbid obesity due to excess calories”.

Has anyone else run into these problems? Did you just pay for your appointments out of pocket?

Soooo I have Anthem BCBS and their policy is similar. They do not cover diet or exercise programs. However, when the Bariatric center I am using billed my insurance for my nutritionist appointment, it was completely covered. These places know what they are doing. I was also able to use my primary for my 6 month requirement which is always covered as a normal office visit. They just need to make notes that you discussed surgery, diet and exercise and weight loss.

Share this post


Link to post
Share on other sites

On 2/5/2018 at 11:24 PM, kakatlady612 said:

Our local BCBS affiliate in my area and state is so poorly regarded its common name is Anthem Doublecross.

Sent from my VS880PP using BariatricPal mobile app

I have anthem in North Carolina. How long did it take for your approval?

Share this post


Link to post
Share on other sites

On 2/14/2018 at 12:37 AM, genia_deanne said:


I too am to annoyed with this. How did you go about scheduling your appointments for the supervised weight loss visits? Out of pocket?

I did just pay the cost out of pocket. I am fortunate to have the means do that, and to have a husband that looked at the total cost and how miserable my weight struggle makes me, and mutually agree it was worth the cost. I know not everyone has those things. It was $70 per visit, times 7 doctor appointments, plus 5 visits with the registered dietician at about $50 each. I'm not sure on the exact number because they billed me after the insurance company rejected their claims. But BCBS did cover two doctors appointments.

Edited by llamalluv
Spelling error

Share this post


Link to post
Share on other sites

I have BCBSM PPO and while the surgery is covered, the pre op appointments for the monthly visits with the dietician for the 6 month supervised weight management is not covered.. The BCBSM claims specialists stated it would never be covered because of the code they use to code the reason for the doctor visit which is a weight management code for “morbid obesity due to excess calories”.
Has anyone else run into these problems? Did you just pay for your appointments out of pocket?


I haveBCBS Federal and my doctor coded it as High Blood Pressure ANDEating Disorder due to Excess Calories and all I had to pay was I-pays. See if your dr’s office can double code the visit.


Share this post


Link to post
Share on other sites

I guess with my program I have care first blue shield and I've never had to pay more than 20 bucks to see a nutritionist like ever but I have diabetes so in Maryland I'm covered because they want you to get rid of the diabetes and now with my surgeons program I am only paying 10 to see the nut

Sent from my SM-T380 using BariatricPal mobile app

Share this post


Link to post
Share on other sites

Per healthcare reform you get a set # of visits (check your plans benefit details) with a dietitian or nutritionist for obesity screening and counseling. If billed as such, then it is considered preventive care & covered 100% by your plan.

The issue is that you are at the mercy of your Dr office & their billing practices. It all depends on what codes they bill. You can't tell them how or what to bill but its worth an inquiry.

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

  • Recent Topics

  • Most popular:

  • Together, we have lost...
      lbs
    ×