Has anyone used BC/BS of Massachusetts insurance for surgery? If so, How was your experience? What were the requirements for you?

I called and I'm told that all I needed was a doctor's letter, having a bmi between 35-40 with a co-morbid disease or being 100 pounds over weight. I'm just curious now because I see so many logs of people who call the insurance company and they are told all the same info., only to be denied when you apply.

Thank you, in advance, for any input.

Hi, I have BCBS MA (PPO). My surgeon submitted all of the paperwork for me - he certified it as medically necessary. The criteria for BCBS MA is very general, this is strait from their site:

Obesity Surgery: We cover the following gastrointestinal surgery for obesity in patients who meet the following requirements below:

• 
  
• Vertical-banded gastroplasty (gastric stapling)1,2,9
  
• Gastric bypass using Roux-en-Y anastomosis short limb (150 cm or less)1,2,9, 12 (open gastric bypass procedure with increased short limb length covered, effective 1/1/05)
  
• Gastric banding consisting of an external band placed around the stomach9,10, 11 Note: The Lap-band system is contraindicated in non-adult patients (patients under 18 years of age) and therefore excluded from coverage.13
  

Patients who are morbidly obese are eligible for obesity surgery if ALL of the following are met:

• morbid obesity (BMI > 40, or > 35 with co-morbid conditions)1
  
• attempts at weight loss have failed1,2
  
• obesity has persisted for at least 5 years2
  
• no untreated metabolic cause for obesity, such as adrenal or thyroid disorders2
  
• patient is an adult1
  

I have been overweight all of my life, my BMI is 51.5 and I was approved in one week (they have even given me 6 days in the hospital if needed). There was no fighting or constant phone calls - they were wonderful.

Good luck,

Thanks Lynn,

I just sent a P.M to you! You have given me some great info.

I have BC/BS mass and it was great for me. I had no problems as I met the necessary BMI and had 2 doctors who sent letters of medical necessity for me. Overall, they did what they said they would do on their part. Good luck!

Brenda,

Thank you for your encouraging message. I am waiting for an approval to be sent out as we speak. I hope that this will be as easy as it was for you and Lynn.

I'll let you know how I made out. I can't imagine that it will take too long for the Doctor to get all the paper work to send along to BCBS.

Thanks Again!

Good luck on Monday, Lynn!!! I'll be thinking of you!

Thanks!! I will keep you posted on how everything goes. (I have my fingers crossed for your approval!)

what dr. and hopital did you use? did they ask for an up front payment for support classes of 500.00, ty i/m in process now

Hi everyone! I know these are old posts but hopfully someones out there. I hav bc/bs anthem HMO I hope it's the same??????

i have bcbs and I only have a bmi of 35 and no co morbities and they approved me

would love to know how you did that my bmi is 36 and so far no comorbidities still waiting on the results for the sleep test but i think it will be negative. My pc did write a letter of medical necessity for me so do you think that will help? I hate this waiting

Hi Haily:

I am from MA too. I had a much higher bmi than yours when I first started.

I looked at your profile and noticed that you are going to Dr. Glasgow. I've been going to the Glasgows since 2007. If there's a way to make it happen they will. Jayne (insurance coordinator and wonder woman!) knows all of the ins and outs of the insurances. I'm sure she'll work with Dr. Glasgow and do all they can to make it happen for you. They are terrific over there:thumbup:.

Maybe I'll see you at one of their support group meetings.

I'll have positive thoughts for you.

Take care.

Sue

The staff at the office seems great so I hope they can make it happen. My husband goes today for his first visit but he should have no problem with insurance his bmi is over 40 and he has sleep apnea. Thanks for the support and also do you find the support groups helpful?