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???!!!

SO-I got a letter from BCBS (the previous insurance that I had) and they denied me. The letter said that I had not had a BMI>40 for the last 3 years and I had no comorbid conditions. They said that I was denied. At the bottom the letter also said that my insurance policy had been cancelled as of Jan 1 (bc we changed to EmpireBlue). Anyway.....so now I am all depressed bc I just have this strong gut feeling that Empire is also going to deny me............AAAAHHHHH I HATE THIS WAIT!!!!!!!!!

My psych eval is DONE! The doctor was kind enough to make sure that the evaluation was in my surgeon's hands yesterday afternoon! That's everything there is nothing else for me to do.

I am calling my surgeon's office around lunch to make sure that they have faxed my eval!

KEEP YOUR FINGERS CROSSED!!!!!

rooting 4 ya!

FINALLY THINGS ARE GOING AT A SPEEDY PACE...my doctors office got the eval yesterday and FAXED it to insurance YESTERDAY I couldnt believe it!!!

whoo!!

now the waiting game begins....drop the insurance company early next week just to follow up and make sure they got it all as needed:rolleyes:

Well,,,,,I couldnt wait I called the insurance company today and guess what THEY ACTUALLY already have the eval on my file!!!!!!!!!!

sounds like a great start kanigag

any word yet?

NO....no word yet. STILL PENDING... I had the doctors office call the insurance company yesterday hoping we could get a rush on this and right now they are waiting on the rep to call them back....I was wanting to have the surgery next thursday...but anyway....I'm not holding my breath this time......still hopeful though!!!

I think you should find out from your Dr. if they require a pre opt and start it now so when you get approved you can already be ready that's what I did so you don't have to wait any longer.

Yeah I have already started that. Drinking lots, and eating lots of protein and low sodium. I'm gonna start the 2 day preop diet on tues...even if I dont hear anything and hope that it goes thru. I talked with my doctors office she said he could do the surgery next thursday we just need the approval!!! KEEP ME IN YOUR PRAYERS CUZ I'M GOOIN CRAZY WAITING!

I will be praying for you ...sending you approval vibes I cannot wait to see you post you was approved :biggrin2:

kaninag,

from my experience you can't wait for the doctor office to do the follow up with the insurance company. It has to be done by you!

Call them up, say my doc office was waiting on a call back...never got the call so I am following up....document who you talk to, what dept their in and time, and what the conversation was about.

I call but they wont put me thru to the nurse the only department I get to talk to is medical management.,.......Dont know what else to do....???!!!

:thumbup::tt1::hurray::hurray::hurray::party::party::party::party::party::party::redface:

I GOT APPROVED!!!

Whats funny is the insurance company CALLED ME this morning...LOL