how long for BCBS approval?

[bamagirl386 0]

I ahve BCBS FEP PPO in Florida & I didnt need anything...not even a drs referral. My policy said that as long as I was BMI of 40 or over, OR BMI of 35 with a co-morbidity (such as Diabetes which I have), I was approved in 3 days. The initial consultation was $250 for me, they get u somewhere, but my insurance verified that my surgery co=pay was only $100.00 & they covred everything else 100%. My nutritional evaluation was more than my whole surgery. Crazy!

Hi,

I have BCBS FEP PPO in California. The surgeon's office said I would probably have to do the 6 months supervised diet thing but when I called the insurance company they said "it is not indicated." So now I am wondering, who should I believe, the surgeon's office or the insurance company? I sure hope the ins. company is right! :thumbup:

The surgeon's office also said my out-of-pocket costs would be in the neighborhood of $4500.00. Did anyone else have this high of out of pocket costs? Next month when I have my first consultation I have to fork over 200 bucks also. Is this normal?

Thanks for any and all help!

Lisa

[rambokitty66 0]

I have Anthem PPO California also. I have to go in for an upper endoscopy on the 8th then my surgeon will submit to my insurance for approval.

[GramaLisa 0]

Rambokitty,

I live in Apple Valley, CA. It's where Dale Evans and Roy Rogers lived and died. The towns nearby are Hesperia and Victorville. We are called the High Desert here. My DH works at the Marine Corps Logistics Base in Barstow. I will be driving what we call "down the hill," or "down below" to San Bernardino to see my surgeon. He works out of St. Bernardine's Hospital, a Center of Excellence. It's only 50 miles one way for me. The first jerk of a surgeon worked out of West Hills, over 100 miles away.

By the way, Paso Robles is my Mom's favorite place on Earth! :seeya: Lisa

[LISAMARIE1158 0]

l have B/C B/S Federal and its been over 3 weeks of waiting...l call them frequently hoping they will get sick of hearing from me...they keep telling me its on so and so' desk awaiting a decision, yet in my policy book it says no approval is needed...Boy of boy l wish they knew what they were doing...the anxiety is terrible as you sit and wait and your fate is in someone else's hands....

[Bimbabe 1]

Hello!

I am waiting to hear from BCBS of RI. I am so excited for you! I wish you the best, keep us informed on your progress!!!

[Ruby124 0]

Well, I am becoming very frustrated. I have BCBS of NJ PPO. My doctor put me in for a Pre-Determination. I was told it could take up to 30 business days. That date passed on 8/15. I have a 27 year old girlfriend who has the same exact insurance I do and she got approved in ten days for gastric last January. I don't think her Dr. put her in for a pre-determination.

Why did I need a pre-determination and she didn't. Everything got paid for her.

[Bimbabe 1]

What is a predetermination?

[Ruby124 0]

I am hoping someone can explain that better to me. :thumbup:

[nursenky9 0]

pre-determination is were the surgeon's office submits all the paperwork to your ins. and a nurse or MD reviews it for medical necessity and to determine if it meets criteria. If it does the ins will pay for the surgery if it doesn't the ins will not pay.

The surgeon wants to know this because it is the reimbursement.

[nursenky9 0]

I have BCBS PPO of PA and they denied me on 8/15/08. Very frustrating. Good luck to all!!

ET.

[CHACHA 0]

Ruby I have BCBS NJ EPO . Went to seminar in april, did all the pre op test psch. letters from Drs , and was submitted July 14th, I called every week and very nicely let them know I was going to pursue this all the way.Last week got approval, so don't give up as long as your insurance doesn't have an exclusion and you meet the criteria they will approve it.

[Bimbabe 1]

Oh, isn't that something everyone has to go through, if you want ins. to pay?

[mariem 0]

I am confused about the process I am in right now. Here is what's going on maybe someone can tell me what to expect.

I went to the information meeting in June. I was waiting for my BC/BS of Mass (Blue Care Select PPO) to take affect. It finally did August 1 so I called the office and gave them all the card details for my plan. The surgeon's office manager called back to tell me that I did not have a bariatric exlusion and that all my details were already on file with them. They said if my BMI was over 40 (which it is) then I am a candidate for this surgery. There were other things mentioned too such as failed attempts at weight loss and a willingness to lose a lot of weight. She said the failed attempts could be something as simple as writing down all my attempts over the years.

She then said she would send this on to their insurance specialist to get 100% information on what is required since I am 100% sure I want to do this. She said based on this call I will get an appointment set up with the surgeon.

Is the call they are making "the" call if they get the right answers? When the woman called me back after initially calling she said "Your insurance seems very easy compared to most" Though I am afraid to let me guard down and get too excited.

[Ruby124 0]

Thank you ,everyone, for your replies. I was away for a few days. I called again yesterday. At least their has been some movement. Someone reviewed the file and passed it off to the medical director. That was most activity I heard in forty days. I guess I will know soon.

nursenky9...I am sorry you were not approved. Are you going to try again? I am getting cold feet myself. I am really afraid of the loose skin stuff...and, doing everything properly & having things still get stuck. Maybe I just need to put a steal clamp over my mouth!!!:cursing:

[nursenky9 0]

I am going back to the supervised WL again and this will be an additional 2 months of supervised wt loss diet. I do not know what they are wanting for the supervised wt loss diet.

Yes I am about to give up. It will be 3 mo on Sept 7. I just want to get the wt off I get short of breath walking and occasionally have chest pain with walking (angina).

On top of this my house caught fire on Aug 20. But my daughters and I are ok.

I get angry over the denial and when I think about quitting I think about being denied and get mad and that is what keeps me determined to loose wt. Other people it seems like get approved in no time and others take for ever. I think they feel if they deny we will give up and quit.

Good luck and keep me posted.

Elizabeth