OK, I have BCBS of Alabama PPO.

According to the rep that I just spoke to these are the following requirements:

1. Medical records from the last 3 years stating ht and wt from Primary care MD

2. participation in a 6 mo weight loss program

3. Hystory and physical from your surgeon

4. and documentation stating that you do not or will not smoke 8 weeks prior to surgery.

My question is this: my current BMI is 43 HOWEVER in 2005 I actually got down to a BMI of 35 will BCBS deny my claim due to this or does anyone know......I have all my records sitting here at my desk and am really discouraged bc I feel like due to this they will deny my claim!!!! Also, I dont have a primary care MD I have always gone to my obgyn...will that cause them to deny my claim???!!!

Yes, your letter was very helpful. I already have everything together needed for them to send in except my december visit to the weight loss doctor. They already have my h&p that the surgeon did, and my 3 years of weight loss.

I will def ask them to fax everything in...I didnt think about that.....oh and yeah after the first of the year my insurance changes instead of them paying 100% they will only pay 80% and plus i will have my ded. Thats why I REALLY want to get this done this year.

The anticipation is killing me!!! I can finally submit my request for the surgery in 10 DAYS!! So, I call the surgeons office today to make sure they had everything..and was talking and she said yeah the surgeon could do the operation this month but that most likely BCBS wont approve it before the end of the year bc they know I will have to pay a deductible come January...and then I will also have to pay 20% this really bites!!!!!!!

Good Luck! Try finding out if your surgeon even has an opening at that time, and explain to the scheduler that if at all possible you want to be scheduled before Jan 1, 2008.... even if it means you go on a cancelation list....... 20% is 20% and is worth the shot! After your doc submits call the 800 on your card and ask for the determination department and follow up with them, try and find out who will be assigned your case and then make sure they are not off for the holidays and politely STAY ON THEM!!!!!

GOOD LUCK!

Yeah, I am scheduled for the surgery 12-27 if BCBS comes thru. I had planned on calling them 2-3 days after the submission. Thanks alot!!!

Now my weight loss doctor is refusing to fill out my last form for my December visit. He filled out the other 5 months but wont fill out this last one....apparently he doesnt agree with the surgery...what the crap can he refuse to do that?? WHAT AM I SUPPOSED TO DO???? I mean I have been going there for 6 months...and all of a sudden he wants to be a jerk at the last minute...GGGGGGGrrrrrrrrrrrrrrrrrrrrrrrrrr:mad:

Sorry to here about this set back. Did the doctor say why he will not fill out the form? Is it because you lost a lot of weight or what? Hard to image that he would have you go through all this and not approved. Is this your regular doctor or the lapband doctor? Have you tried to get back in and sit down and talk to him and explain how you feel about this and all the money, time, enegery and effort you have spent with this hole process. If you need any help we could start a letter campaign and hope that he will send it in for you.

Chris

This is the weight loss doctor that I started seeing before I decided to have the lap band. But I decided to keep going there bc I had already started their program. He doesnt believe in gastric surgeries he said. But see he filled out the first 5 months of paperwork but wont fill out this last month. I asked the nurse well make me an appt so that I can see him she said the first she had available was 12-28 well HELLO I said right now I am tent. scheduled for surge 12-27 but they dont care...so I had my surgeon request my records and I hope that that will be good enough.

Well, the time has finally come. I will take the rest of my info to the surgeons office today. They will fax everything to BCBS of Al tomorrow. I called BCBS and asked if they ever put rushes on approvals. And I explained everything to the lady--she just laughed and said that I needed to expect at least a 30 business day wait.......oh well.

Hope your approval comes in record time! Some people get them very quickly.

I just called the surgeons office to make sure that we def had everything and she is actually submitting my request today...I am sooooo happy!!!:clap2:

Oh I hope you hear something soon! The waiting is the worst part of the process.

Does anyone know another number to BCBS of Alabama besides the general customer service number? These ppl that I talked to yesterday dont seem to know what they're talking about. They said they have not received any of my paperwork. And then they said that it would need to be refaxed for medical review....which we did yesterday. How in the world did some of you get approved so quickly when I cant even get to talk to anyone that says they have even received my papers (which were faxed last thursday and yesterday.)

I would suggest that you get a person name, phone number and fax number. Also get a complaint number that can be put on the fax and paper work. My wife and I had the same problem with United Health Care but once we had that the doctors office was able to resend and obtain approval. If you have any questions just e-mail me or ask on here.

Chris

I had the same problem its two different dept. Customer Service and Care Coord. dept. and customer service can't see certain information, so I would said make sure you are contacting the correct dept. ask to be transfer to a Care Coord.

I called again and they did receive everything!!!!! :) :)

I am currently under review!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Thanks for all the support!!!!!!!!!!!!!!!!!!!!!!!