Hello everyone,

I have blue cross blue shield, I’ve been required to do a 6 month nutritional list program, psychologist evaluation, Cardiologist and pulmonologist and have been cleared for everything . My Surgeon just submitted my paperwork to insurance and I was denied due to my psych evaluation being not sufficient? She met the requirements for the surgeon and she gave me clearance saying I was a good candidate. Has anyone had this experience? What can i do to get insurance to change their mind?

I would contact your insurance and find out from them exactly what they are needing the psych eval to show. Maybe its missing a certain question/answer that they want to have. And then contact the provider who did the eval and let them know. More than likely, they can adjust the report to what the insurance needs without you having to come in.

I agree, contact Blue Cross to see what they need. I have BCBS and was approved, and I bet it is an easy fix for you! Good luck!

I was denied the first time as well, although not for psych reasons. My surgeon recommended that she contact the insurance on my behalf. She did so and answered their questions, and I was approved shortly thereafter.

Thank you guys!! I appreciate the feedback, my surgeon has scheduled an appointment with insurance to discuss what needs to be fixed to move forward

Hang in there. It's like these insurance companies don't really want to spend the money on you so they often deny the first attempt hoping you'll give up. If you jump through the right hoops you should be OK as long as you are willing to play the game!

I have BCBSTX and when I initially tried starting the process they refused to cover any portion since it was an elective surgery. I had to get recommendations/referrals from my Primary, a dietitian and a therapist (the usual process) to prove this was a health NEED. Just approved last week and no have to start the process all over again.

On 4/10/2020 at 11:10 AM, Lynda486 said:

I agree, contact Blue Cross to see what they need. I have BCBS and was approved, and I bet it is an easy fix for you! Good luck!

Hi I was wondering what plan you have? I have insurance through my job bcbstx platinum PPO. My HR say weight loss is covered but when I call bcbstx they say it is not covered and every plan summary is uBariatric is excluded. I’m confused