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???!!!

Read the thread started by Dustout "Approved by BC/BS. You'll that my experience was very similar. But I was approved after 6 weeks. And was banded yesterday!

Congrats Ellisa!! I did read that thread and you went thru a lot!!! Luckily I have read all these threads and I knew what to expect. I only gave them a few days to get the paperwork and when they still didnt have it in the system I refaxed. I'm not playing with these ppl. You know to me-- I want the surgery. My BMI is high I have done everything that they asked....now give me my freaking approval...you know......but yeah I know it doesnt work like that. I want SOOOO badly to call today but I will wait until friday. If I havent been approved by friday then I wont be having it before the end of the year. But oh well as long as they approve it.:clap2::clap2::clap2::clap2::clap2::clap2:

Hang in there, and next time you call, firmly but politely insist on being transferred to a nurse. Once the nurse was involved things moved at lightning speed!

Yeah, I just called BCBS again and they kindly reminded me that predeterminations are done as a courtesy and that it can take up to 30 business days....basically they're tired of me freakin calling but you know what if i dont have an approval by tomorrow then i can just hang this up for this year. which sux!!! I am soooo frustrated. I hate that my surgery lies in BCBS's hands....

*the BCBS girl said there was nothing they could do at this point to rush anything bc it is under "medical review"

Once mine got to the review stage it moved quickly. Hopefully yours will too.

Oh well, I am not having the luck of a quick approval. I have 3 hrs left to get it approved so that I can have the surgery this year. It doesnt look good. My Dr's office closes in 3 hrs and 10 min and wont be back open again until the day that we had tent. scheduled my surgery *tears* I just called BCBS and it is still in review.....this sux. I am so depressed now. Well, I will just call back before the dr's office closes that will be my last hope.....yeah I know I am whining....but I cant help it. If it doesnt get approved today then i have to pay for 20% of the cost...and thats IF they approve it...surely they wouldnt make me wait so long if they were just gonna deny me...maybe somebody is in the Christmas spirit..............

You are not whining. You have every right to be frustrated. And 20% of this surgery is a lot of money. It's just a shame that we are at the mercy of their slow wheels turning. It seems like they should have some responsibility for a maximum amount of time they are allowed for a response. Come here and complain all you want. That's what we're here for. Folks helped me just by understanding.

Thanks Ellisa!! Well, still no word

That's ok no word is better than a denial......

You are right, you haven't been denied and that's huge. When I called once and they told me that I hadn't met certain requirements, I thought that they must have lost 1/2 of my paperwork (which they had) and I thought it was a denial. When I got the letter that said "pended" I was really confused. But once I realized that it wasn't actually denied, I was relieved but still very concerned that it still could be denied. Eventually it all came together. I certainly hope it does for you. The waiting for approval seems eternity! But once you get it, things move along pretty quickly. I felt like I didn't really have time to get nervous about the surgery because of all the preparation.

AAAAAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!!!

You know, after reading about a lot of ppl's speeding approvals I kinda expected mine to be fairly quick....I TOTALLY SHOULD HAVE KNOWN BETTER...this is crazy!!! STILL NO WORD!!!

I understand perfectly. Even one of the ladies in my doc's office said she got her approval in 2 weeks, but that they are told to tell people it can take up to 6 weeks (which it did). Of course I wanted the two weeks.

Hang in there, I know it's hard, but keep coming here to AAAAAAARRRRRRRRRRRRR...

I hadn't told very many people under after I got my approval. So it was really hard going to work and being around people and not crying on their shoulders, but I could come here and AAAAAAAAARRRRRRRRRR away!

:heh:

well I want to AAAAAARRRRRRRRR

I have not heard anything neither....I am also praying for a good XMAS spirit or a good New Years spirit and get and approval back....it's "under review' is what I was told last week...all 15 pages..my doc sent......is what they said...LOL...

ARRRRRAAAAARRRRRRRR

OMG I am getting nervous for u guys I fiqured it was the end of the year and they would be approving people fast ... sorry but I FEEL APPROVAL VIBES FROM YOU GUYS

Hang in there! Try not to let it get to you. It got to me, big time I gained 5 lbs from the time I went in for my original consult until I had my pre op appointment! Don't do that... stay in preparation mode, if you can.

I'll keep checking on you.