BC/BS of Mass Gastric Bypass Approvals / Denials

[SimoneMonet 62]

Hi All:

I was wondering regarding BC/BS of Mass gastric bypass approvals. I received the pre-auth form. I have a BMI of greater than 50 with 2 co-mobidities sleep apnea and diabetes. I've met all of the other testing and nutrition criteria except for the psychologist visit.

Is 6 mos pre-dieting is required for approval?

Is pre-surgery weight loss required for approval? I was wondering if anyone was denied for gaining weight prior to the surgery.

[porkytits 5]

I know this is a month later, and I'm sure you've gotten your answer elsewhere by now but I have BCBS of Mass and I went to my initial consult 4/27. By the time I got to the appointment my surgeon's office had already contacted my insurance to gather the requirements. I was told that I had to do three weigh ins but was not required to lose anything, just not to gain anything. And I had to go through the surgeon's program which consisted of psych eval, nutrition class, endoscopy, blood work, etc. They gave me a surgery date within a month of my initial consult. I went through the program with no issues and the surgeon's office called me about a week and a half before surgery (8/6) and told me I was approved. It was really painless and was told BCBS of Mass is one of the easiest ones to work with. I hope this helps you on your journey.

Edited August 16, 2018 by porkytits

[Frustr8 7,886]

Sounds pretty cool,all around. Lucky You!

[Walter Lindstrom 42]

BCBS MA does not have a specific 6-month supervised weight loss requirement. The link for their most recently updated medical policies is http://www.bluecrossma.com/common/en_US/medical_policies/medcat.htm . Under O you'll see Obesity Surgery (medical policy 379). I've also attached it. Hope this helps. Good luck.

379 Medical and Surgical Management of Obesity including Anorexiants prn (1).pdf

[SimoneMonet 62]

On 8/16/2018 at 12:43 PM, porkytits said:

I know this is a month later, and I'm sure you've gotten your answer elsewhere by now but I have BCBS of Mass and I went to my initial consult 4/27. By the time I got to the appointment my surgeon's office had already contacted my insurance to gather the requirements. I was told that I had to do three weigh ins but was not required to lose anything, just not to gain anything. And I had to go through the surgeon's program which consisted of psych eval, nutrition class, endoscopy, blood work, etc. They gave me a surgery date within a month of my initial consult. I went through the program with no issues and the surgeon's office called me about a week and a half before surgery (8/6) and told me I was approved. It was really painless and was told BCBS of Mass is one of the easiest ones to work with. I hope this helps you on your journey.

Hey, Thank you for replying. I actually JUST got cleared for surgery by the doc, just waiting for the insurance approval. I *did* gain a pound. Hopefully I won't be denied b/c of that.

[KSan35 0]

On 8/16/2018 at 12:43 PM, porkytits said:

I know this is a month later, and I'm sure you've gotten your answer elsewhere by now but I have BCBS of Mass and I went to my initial consult 4/27. By the time I got to the appointment my surgeon's office had already contacted my insurance to gather the requirements. I was told that I had to do three weigh ins but was not required to lose anything, just not to gain anything. And I had to go through the surgeon's program which consisted of psych eval, nutrition class, endoscopy, blood work, etc. They gave me a surgery date within a month of my initial consult. I went through the program with no issues and the surgeon's office called me about a week and a half before surgery (8/6) and told me I was approved. It was really painless and was told BCBS of Mass is one of the easiest ones to work with. I hope this helps you on your journey.

Can I ask what hospitals you all went to? I went to my initial consult at UMass at the beginning of October and they refused to make any of my appointments any closer than one month apart although Blue Cross Blue Shield of MA did not require the 6 month time frame.