cmathews77

I really didn't know where to post this b/c it isn't a surgery question, but I figure most everyone on here (if your surgery was covered by insurance) has been through this. Anyway, I am a month and a half away from being able to submit to insurance and I have my psychological evaluation on Monday and I am reeeally nervous about it. I guess I'm afraid that they will confirm what I've know all along...that I'm CRAZY! Just kidding...not crazy. I just don't know what to expect, what questions they will ask, will there be any trick questions? If anyone could give me any advice, or simply what you went through, would be greatly appreciated. Thanks a bunch!!!!

Thanks everyone for the advice. I had the evaluation and it was just like each of you said...no big deal! Thanks so much for your help!!!

Ok...I have BCBS of Alabama. I am 4 months into my 6 months supervised diet. I am scheduling all of the testing that has to be done and I have some questions. First of all, I saw my bariatric surgeon a couple of months ago and my insurance claim for that appointment got denied b/c the insurance hasn't approved me for the surgery yet. My question is...do I have to pay out of pocket for all of these tests (psych eval, nutritional eval, labs, etc.) since I haven't been approved by BCBS yet? I called BCBS and that can't say for sure b/c they don't know how these places will code the tests. Anyone with the same experience?

First of all, I have BCBS of AL and it does cover WLS. So, I am on month 2 of my 6 month supervised diet. I went to see my surgeon a few weeks ago and they gave me a list of other appts. that I've got to have with other doctors (ex. psych visit, nut. visit, sleep apnea test, ect.). My question is how are those appts. covered under my insurance since I haven't been approved for the surgery. The surgeon's consultation was filed on my insurance, but I got a bill today for over 300.00 with my insurance not paying any of it. I can't afford to pay it and out of pocket for all of the other tests and appts. that I've got to have. Anyone else have an issue with this? Can anyone offer any advise as to how your insurance worked or what you had to pay? Thanks a bunch! Connie

I finally spoke with my insurance. The lady I spoke with wasn't sure why it was denied since my policy does cover wls, so she resubmitted it and kept track of it to see if it was denied again and why. She called me back a few days ago and said that it was denied again b/c I haven't been approved for the wls yet. She said I could either work it out with my surgeon's office to wait until approval to pay for the visit or go ahead and pay the surgeons office and get reimbursed. I hope this is not the case for all of my other visits and tests.

I am just beginning this long journey and I see my PCP for the 1st time on Wednesday to start my 6 mth supervised diet. My fear is that he will not want me to do it and refuse to go along with signing off on my weight loss attempts and my clearance letter. I'm guessing he's going to try telling me that in my 6 month supervised diet that if I try I will be able to lose a lot and shouldn't have the surgery. Anyone dealt with anything like this before? I guess I 'm thinking my doctor will say that b/c that is what my husband keeps saying!

I am just beginning this long journey and I see my PCP for the 1st time on Wednesday to start my 6 mth supervised diet. My fear is that he will not want me to do it and refuse to go along with signing off on my weight loss attempts and my clearance letter. I'm guessing he's going to try telling me that in my 6 month supervised diet that if I try I will be able to lose a lot and shouldn't have the surgery. Anyone dealt with anything like this before? I guess I 'm thinking my doctor will say that b/c that is what my husband keeps saying!

So, just started my 6 month diet required by insurance. My question is this....my BMI is currently 41. If I do my 6 month diet that the insurance requires, loose weight and fall below my 40 BMI requirement, will insurance still approve me? Anyone with any experience on this? Thanks!

Thanks y'all. My current BMI is 41, but throughout the last 3 years, it has dropped to 39. jsayles, good luck with yours and keep me posted!

Thanks so much for your help! I called my PCP yesterday and have an appt. with him next Wed. to get the 6 mth diet started. I hope he doesn't give me any problems about it. Thanks and good luck!

Just curious on some of the things you had to go through for approval.

I am in the very early process of this and my consultant said she wasn't sure if doctor would do it since I had a hernia repaired 2 years ago above belly button. Anyone experience this?

Thanks y'all! The consultant said she was "new", so maybe that explains some of it. She said she thought there might be a problem if I had a hernia repaired with mesh and asked if it was above or below the belly button. I told her above and asked her why. She said she thought there might be a problem if it was above the bb or below the bb...she couldn't remember?!

I'm at the VERY beginning of my process. I still have so many questions and don't even know where to begin...do I start by call the surgeon's office or my PCP? My insurance requires 40 + BMI with no problems or 35 + with problems. You've got to show documentation of this for at least 3 years. Also, got to have supervised diet for 6 months. The concerns I have are this...1. My BMI is over 40 but has flucuated for the past three years. I had a baby 2 1/2 years ago and was very sick so I lost a lot of weight during pregnancy and after I had her I was down to around 200 but quickly gained it back. So, I'm not sure what they will say about that. 2. I have been to numerous drs. about my weight over the years, but don't have 6 consectutive months to show. Like I said, I don't even know where to start! Any suggestions?

So, I am very new to this and still have so many questions. I have done tons of research on the different surgeries and have found that this is the best for me. I called my insurance and they do cover WLS, however their are certain qualifications that must be met...BMI over 40 (or 35 with additional health problems), and 6 months on a supervised weight loss plan with at least 3 doctor's visits during that time. I have been on many weight loss programs, but don't have any documentation of this and it has been consistant. Each time I'm on a weight loss plan, I do lose weight, but then end up gaining it back. My question is this, if I join a weight loss program and lose weight then I will fall below my required BMI. Any suggestions? I have BCBS of Alabama. Any good surgeons in Alabama that you would recommend? Thanks for your help!