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anyone have highmark bcbs

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I have highmark bcbs and my ins received my info on 7/7/08. The precert said they would return a reply within 15 days. Today is the 18th of July and they contacted my surgeon re: the docs name at the wt loss clinic so I gave that info to them. This ins has a 6mo wt loss cumulative within 2 years of the request. I have wt watchers, curves, LA wt loss, Ageless WT loss center- the physician they asked for, Total Med-I saw a nurse practitioner and she prescribed meds. I have 10 months worth and my PCP referral letter stating recommend lapband d/t comorbidity of high lipids joint problems. My BMI is 39.

I am hoping this doesn't mean they are going to try and deny me. Anyone else had any dealings with highmark bcbs?

I work for chain of hosp. and this is the ins we have. It has been great for every thing else.

Thanks, ET:unsure:

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No, I do not live in PA I work for Select Specialty Hosp. that is based out of Mechanicsburg, PA. This is the ins they carry. I went to their hospital in Hattiesburg for a visit.

How have u done with your lapband?

I am just so anxious waiting on the approval. Don't want a denial.

Good luck and thanks for responding. ET

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The ins company would not take several months of the diets. They would not use the LA wt loss or Wt Watchers. I have my PCP and am hoping they will allow it submitted this info on 7/25/08. Hoping to hear some positive news this week. ET

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Have you heard anything back? My paperwork was submitted to highmark bc/bs Teusday and I was approved by Friday. Surgery is scheduled for the 13th. Did ekg, chest XR, and blood wrk Yesterday, Had endoscopy today.

Good luck to you. I hope you get your approval soon

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Heather it is Aug 14, 2008 and still pending. When we resubmitted (they received it on July 25) the PCP's supervised wt loss surgery they said it could take up to 30 days.

I have Highmark BCBS of PA which did u have?

How are you doing? Are u just thrilled?


Edited by nursenky9
needed to put date of resubmission

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I had highmark bc/bs of PA also. I hope you get your approval real soon. I had my surgery Wed and I am doing great. I am posting the details of my surgery soon. But I am surprised at how well I feel.

Hope you will be joing me soon

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I called my insurance co today and they said I was denied. They reported it as not being medically necessary. They also told me that they did not receive a psychological eval, nutrition, or the supervised WLS.

I went through the psych eval and nutrition class. I don't know what's up with that. I am wondering if when the surgeon's office resubmitted if they did not resubmit all the paperwork since the ins company had some of the papers already.

They said they needed the medical record. That the surgeon sent a letter and not the evals.

What did your doc send to them? You got approved so quick!! That is awesome!!

What did u use for the WLS?

I went to a wt loss clinic. called Total Med were they gave me Phentermine and B12 injections weekly.

Ageless WT Loss center were they gave me phentermine and counselors.

I will contact the surgeon's office on Monday to see what is going on. Very discouraging.

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