how long for BCBS approval?

[*slim* 2]

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.

Basically you are waiting to find out what hoops the insurance company wants you to jump through for approval. Some are easy and only require that you be over weight and have a doctor say you need the surgery or will benefit from the surgery. Others (like mine) require that you have a supervised weight loss plan for 6 months in the last 2 year, plus 5 year history of obesity, and some type of comorbidity (i.e. sleep apnea, diabeties, high blood pressure, etc). Thankfully, I had been going to my doctor quite a bit the last couple of years. They were able to document my weight and also document over a 6 month period that we discussed my weight, diet, and exercise. Since she said that yours is easier than most, maybe you won't have to wait a long time.

Good luck to you!

[SashaVaughn 0]

I have BCBS of North Carolina, and I was approved within a week of my doctor submitting all of my "paperwork". I swear I was so ready to start war with the insurance company. The clinic I'm going thru advised the approval process can take several weeks. Needless to say...I'm glad I was the exception. My doctor was even shocked.

I was approved the 2nd week in August but I'm getting banded on 9/15. :thumbup:

[crzytchr 3]

My approval with BCBS of La was very easy. I called the dr's office on June 24th, was approved June 26th, had preop on July 3rd and surgery on July 14th. So, basically it was 3 weeks from my phone call regarding a consultation until my surgery. It went sooooo quick. It must be the individual employer who sets the plan up who decides whether or not there are general exclusions and how many hoops you have to jump through. I did all my pre-consultation paperwork online with my surgeon (took a little over an hour) and the rest was a breeze.

[Bimbabe 1]

NurseKY:

I really don't get it! A person who is overweight and is having Angina certainly should qualify for this procedure, no questions! The insurance companies still don't get it. This is a procedure that, in the end, will decrease your risk for heart dz, diabetes, Cancer among other issues.

I just get so frustrated with the ins. companies. !