What will BCBS insurance pay for?

[Thegirl8567 0]

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?

[VSGnewguy 164]

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.

[orionburn 1,023]

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.

[Diana_in_Philly 1,426]

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.

[crystal0727 39]

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!

[kakatlady612 1,053]

You know what- in Ohio we call our local BCBS affiliate, Anthem? Anthem Doublecross.

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[Jerseygirl4523 44]

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?

[Jerseygirl4523 44]

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.

[Sprinkles1 358]

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.

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