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Good Luck on your journey!

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Took a few months and got state of Illinois involved. I was denyed twice because they didnt want to fix their records. State of Illinois got involved at over turned the verdict.

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Took 3 days to be approved after the doctor submitted all of my records.

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Since these are independent members of the national "Blue Cross and Blue Shield Association" it's unfortunate but not all "Blue Cross Blue Shield" companies treat bariatric surgery in the same way. Some are great - others? Not so much. Let us know which specific company you're with and where you are located so you can get the right answer, FOR YOU. Here is a link that identifies all the BCBS Association members in case it helps anyone:

BCSB Companies and Licensees

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Took a few months and got state of Illinois involved. I was denyed twice because they didnt want to fix their records. State of Illinois got involved at over turned the verdict.

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Why did they deny you twice. I'm not quite sure what you mean by fix their records. Is the state of Illinois pretty strict on what the approve with our insurance?

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Since these are independent members of the national "Blue Cross and Blue Shield Association" it's unfortunate but not all "Blue Cross Blue Shield" companies treat bariatric surgery in the same way. Some are great - others? Not so much. Let us know which specific company you're with and where you are located so you can get the right answer, FOR YOU. Here is a link that identifies all the BCBS Association members in case it helps anyone:
BCSB Companies and Licensees
I have the centennial care in New Mexico

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2 minutes ago, lilDanille said:

I have the centennial care in New Mexico

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Ahhh - - that's the New Mexico Medicaid plan offered through BCBS New Mexico. They will undoubtedly have a separate set of "rules" which might differ from "traditional" BCBSNM medical criteria. Your surgeon's office (Prebyterian perhaps?) should be able to walk you through that specific process and time frames involved. Good luck!

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Ahhh - - that's the New Mexico Medicaid plan offered through BCBS New Mexico. They will undoubtedly have a separate set of "rules" which might differ from "traditional" BCBSNM medical criteria. Your surgeon's office (Prebyterian perhaps?) should be able to walk you through that specific process and time frames involved. Good luck!
Thanks

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Why did they deny you twice. I'm not quite sure what you mean by fix their records. Is the state of Illinois pretty strict on what the approve with our insurance?

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BCBS of IL. Kept saying that I was having a lapband removal at the same time as getting sleeve done. I had the lap band removal in September and they approved it . We dont know why they kept saying that both would happen at once. The dr. Didnt submit it this way. Also this was the 1st time GERD was part of the reason to deny the claim.

GERD was never submitted as a reason to remove lap band.

Anyway. We appealed to the state of Illinois because of all this and they told them...to approve the Sleeve.



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16 hours ago, lilDanille said:

So you did the 3 dietitian visits and then you were good to go

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No they required 6 monthly visits with pcp. I did one on April 30 and then the 6th one I did the first week of October to shave off a month. I was worried after the fact that they'd say that was only 5 months worth of visits but technically there were 6 actual visits each in a different month. I only needed 1 visit with the dietitian. And one psych eval. The glitch that caused it to take an extra couple of weeks was I had to prove my weight from the 2 years prior. I hadn't gone to the doctor during that time so I had to get my weight history from one of those scammy phentermine clinics I had gone to. I called them like 10 times and someone was always going to send the info and they never did. And the bariatric surgery place requested the info twice. Finally I drove to the phentermine clinic and begged the young reception guy to send the info.

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I have Anthem BCBS. When did you get your surgery date? Was if after your 6 month program was finished and insurance approved you? Or were you able to schedule it before the approval (contingent on approval of course).

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