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

What will BCBS insurance pay for?



Recommended Posts

My husband is starting the process for gastric sleeve. We have BCBS IL which doesnt require the 6 mo diet. We have already paid for the consultation with the surgeon and nutritionist appointment (both out of pocket, neither submitted to insurance). He has a cardiologist appt scheduled, and needs to have an endoscopy.

My question is- when does the surgeon normally get approval for the surgery? And arent these other appoinments (ie cardiologist) normally covered? How are they covered if the surgery approval is not done yet?

Share this post


Link to post
Share on other sites

I have BCBS IL and they covered most of my costs. However, I already had a cardiologist so I have just paid the copays. Where I did go out of pocket, for my surgeon, is for the lifetime nutritional counseling. Your surgeon's office should give you a break down of all the expenses and what you will be responsible for.

Share this post


Link to post
Share on other sites

I have BCBS but I'm in Indiana. You have to keep in mind policies are going to vary between states and whatever the employer/insurance company has worked out. One company may not include WLS in their policies while the next does.

That being said my experience with BCBS everything was covered as it normally would be for a doctor visit or procedure. Basically you had your co-pays as normal and that was it.

Share this post


Link to post
Share on other sites

The only way you will know is to call the number on the back of your card - every policy is different - even within the same state policies differ. Make the call and ease your mind.

Share this post


Link to post
Share on other sites

I have BCBS TX and and I had the normal copays for all visits. My surgery was actually scheduled long before I was approved. After my last medical clearance appt on 11-30, it was submitted to the insurance company and took 7 days to get the approval notification. Luckily I still had another 6 days to go before my surgery date - talk about cutting it close!

Share this post


Link to post
Share on other sites

On 1/31/2018 at 9:47 AM, Thegirl8567 said:

My husband is starting the process for gastric sleeve. We have BCBS IL which doesnt require the 6 mo diet. We have already paid for the consultation with the surgeon and nutritionist appointment (both out of pocket, neither submitted to insurance). He has a cardiologist appt scheduled, and needs to have an endoscopy.

My question is- when does the surgeon normally get approval for the surgery? And arent these other appoinments (ie cardiologist) normally covered? How are they covered if the surgery approval is not done yet?

Why did you pay out of pocket, are they in network?

I have Anthem BCBS and they have paid for everything. I still had to meet my out of pocket max first of course. My surgeon’s office was able to get the nutritionist and exercise consults covered. My endoscopy ended up costing me maybe $1200 because I hadn’t met my deductible yet. It’s been a smooth process so far.

just waiting on this 6 month rule... anyone know if it actually has to be 180 days?

Share this post


Link to post
Share on other sites

They are covered as normal visits and tests that a doctor has deemed necessary. The surgeon’s office will submit to insurance for pre approval of surgery when all of the items that heir office and your insurance requires are completed.

Share this post


Link to post
Share on other sites

I have bcbs IL too! My nutritionist appointments were $0-25 after insurance. My endoscopy was $1200... but, I didn't meet my deductible until then. I got approval from bcbs the same day my doctor submitted for approval. Literally took them like ... not even 2 hours for the approval. I was shocked. I had to complete 4 nutritionist appointments (2 each month) before submitting, per the hospital, not the insurance.

Sent from my SM-G955U using BariatricPal mobile app

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

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×