According to B/C and B/S l don't need prior approval for lap banding, yet my surgeons office states l need prior approval.... l even called the insurance company back several times just to make sure. l feel like l'm left in limbo, but this time by the surgeons office...Naturally the person who does all the insurance billing for the surgeon, was out sick today...another long week of waiting, hoping and praying that this would all work out...:thumbdown: My surgeons office seems to be so disorganized...

Find a new doctor who is willing to fight for you. That's what I did. I also have BCBS. I'm in Illinois and had no prior approval needed. Just a BMI of at least 40. Good luck.

I have BC/BS Federal. They won't give prior approval if it's outpatient surgery. They will, however, tell the dr. (and you) if you meet their eligibility requirements. That should suffice for the dr., especially since you have to sign all kinds of stuff that says you'll pay if the insurance doesn't. If they don't know how to deal with BC/BS Federal, I'd find someone else. See what the insurance person says next week.

Stephanie

I have FEP BC/BS and I got prior approval from them before the surgery. My doctor required it before committing to surgery. Once all of the paperwork was completed I received approval in a couple of days. They are my secondary insurance and still approved it. I have Medicare as my primary.

They told me they didn't do prior approvals, just to be sure I met their requirements. I did, and they reimbursed me 90% of my surgery in Mexico.

My surgeons office is so dam busy that they have lost the human touch part of the surgery....we aren't just numbers...when all is said and dione, l will definately voice my opinion to my surgeon...sad to think they are so ig they don't have to care...they forget its us paying their salaries..

I have BCBS Federal Standard Option and I am going through the same thing with my doctor's office. But when I called BCBS they gave me a number and said it was to an office that dealt with WLS so I called and it turned out to be one of the people who actually approves patients. She asked me how I got the number and what was the name of the operator. I told her that I did not ask since she helped me and there was no reason to take her name down.

I figured since I had her on the phone I am going to ask what she looks for to approve patients. She said what is stated in the employees benefit guide and while it does not mention any documentation or co-morbid for BMI 40 and over which I am. She looks for a package from the surgeon that includes weight loss history (no time line was mentioned), diagnostic testing (Upper GI, sleep Study, Blood Work, etc...), and a Psychological exam.

She gave me an example of what is not acceptable. She had two pieces

of paper in a patient's file and she said that's not good enough and this patient's surgeon should know better.

She also mentioned that once she approves it to go forward the file is sent to a management end for final approval. She told me that surgeons should be very familiar with their policies and that your file should contain a lot more than two pages.

I have a cardiology test and a sleep study to go through. Once they are done and the doctors reports are sent to the surgeon that should be it

I hope . My doctor will not schedule surgery until approval has been received and I am okay with this. I want no one to come back to me and say that I did not have their approval even though they said they did not require it.

... did pre-approval on my surgery, no problem.

Weird, isn't it, how despite BCBS FEP being a national program it still makes a difference which state is managing the FEP contract? :ohmy: Some of them give enrollees a run around, and some make it smooth. Hang in there!