Timeline

[fromsleevedtome 50]

Hello, I am just begining my lap band journey and was wondering if there is anyone who has already gone through the process who can tell me generally what the timeline for approval is with Blue Cross Blue Shield. I am just wanting a general idea of the steps in the process that Blue Cross requires, and a general timeline for completing those steps before they approve the surgery. Any information would be greatly appreciated.Thanks!

[MelindaH 3]

Hello, I am just begining my lap band journey and was wondering if there is anyone who has already gone through the process who can tell me generally what the timeline for approval is with Blue Cross Blue Shield. I am just wanting a general idea of the steps in the process that Blue Cross requires, and a general timeline for completing those steps before they approve the surgery. Any information would be greatly appreciated.Thanks!

hi, are you BCBS Federal or regular BCBS. I can help you with the Federal plan if that is what you have.

Melinda

[Cindy C 150]

I had BCBS of Michigan when I had my surgery and it went very quickly. I needed a psych eval, some labs and a 6 month supervised diet. My PCP said due to my past attempts he was able to write in his letter that I had already met that requirement. We had open enrollment in April and I discovered that it was covered. My company changed to BCBS as of May 1. I went for my consultation with the surgeon on May 15 and had my surgery on June 10. So it was a total of 3 1/2 weeks.

[fromsleevedtome 50]

hi, are you BCBS Federal or regular BCBS. I can help you with the Federal plan if that is what you have.

Melinda

I have the BCBS Federal plan. What is the timeline like for them? Thanks for your help!

[MelindaH 3]

I have the BCBS Federal plan. What is the timeline like for them? Thanks for your help!

I am on BCBS Fed Standard. I started the end of April with a seminar at a Center of Excellence here in Eugene, OR. You complete an 18 to 20 page questionnaire about your history of obesity and your medical history as a whole. Then they will call you for a consult appt. Mine was the end of May. Went really well. My BMI was 37.4 and I have several co-morbities. After the MD appt, I met with their insurance co-ordinator who informed me that BCBS requires the following: 1) a documented weight history showing obesity for two years 2) documentattion of any weight loss attempts you made within the previous calendar year before you met with the surgeon--just a brief statement 3) three months of consecutive nutritional counseling. 4) screening by a psychologist.. The MD may send you to various specialists ie: cardiologist depending on your age, gastroenterologist for endoscopy, visit with your primary care to establish their support, perhaps a sleep specialist to rule out sleep apnea, perhaps an orthopedic consult. The consults will vary from patient to patient. After you complete all of the above, they (surgeon's office) will send your records to BCBS (usually by fax). My ins lady said it takes one to two business weeks. If everything is in order, it is usually approved very quickly and then they will schedule you within that month. Oh, one last thing, the surgeon requires that you lose 5-10% of your weight. before pre-op.

I hope this helps. Feel free to contact me if you have further questions. I have one more nutrion session then mine should be ready to go to BCBS. Hoping for surgery the end of Sept or so.

Melinda

[Grider 92]

I am on BCBS Fed Standard. I started the end of April with a seminar at a Center of Excellence here in Eugene, OR. You complete an 18 to 20 page questionnaire about your history of obesity and your medical history as a whole. Then they will call you for a consult appt. Mine was the end of May. Went really well. My BMI was 37.4 and I have several co-morbities. After the MD appt, I met with their insurance co-ordinator who informed me that BCBS requires the following: 1) a documented weight history showing obesity for two years 2) documentattion of any weight loss attempts you made within the previous calendar year before you met with the surgeon--just a brief statement 3) three months of consecutive nutritional counseling. 4) screening by a psychologist.. The MD may send you to various specialists ie: cardiologist depending on your age, gastroenterologist for endoscopy, visit with your primary care to establish their support, perhaps a sleep specialist to rule out sleep apnea, perhaps an orthopedic consult. The consults will vary from patient to patient. After you complete all of the above, they (surgeon's office) will send your records to BCBS (usually by fax). My ins lady said it takes one to two business weeks. If everything is in order, it is usually approved very quickly and then they will schedule you within that month. Oh, one last thing, the surgeon requires that you lose 5-10% of your weight. before pre-op.

I hope this helps. Feel free to contact me if you have further questions. I have one more nutrion session then mine should be ready to go to BCBS. Hoping for surgery the end of Sept or so.

Melinda

[Grider 92]

:rolleyes:HI there! Ms Love and Belinda... FEPBLUE (basic) here in Fla.. I am pre -op going to 2nd visit Monday, and had my psycologist visit last Thursday and moving forward. Thanks for you input as how the INS. operates, I have worked hard to get the paperwork ready for my surgeons office to submit when the time comes. I had on gal tell me it took her 30 days for approval in TX. and another here in my neck of the woods in 2 days. I am praying for a fast turn around as my last visit is around Oct 10,,, then the holidays etc!

Being in Fla. all the hospitals fill up with tourists until April. I wonder why they come some times!

I am really praying to get done before then. I have not lost anything so far.. month one. I do not want to get below my BMI of 40. I'll lose with the milk shakes I guess, but I'v heard if you go below- you can be turned down.. and if do not lose at all you can be denied,,dumb rules!

Glad to meet my peers, how are you doing Belinda! and Ms Love, I send you encouragement!

[MelindaH 3]

:rolleyes:HI there! Ms Love and Belinda... FEPBLUE (basic) here in Fla.. I am pre -op going to 2nd visit Monday, and had my psycologist visit last Thursday and moving forward. Thanks for you input as how the INS. operates, I have worked hard to get the paperwork ready for my surgeons office to submit when the time comes. I had on gal tell me it took her 30 days for approval in TX. and another here in my neck of the woods in 2 days. I am praying for a fast turn around as my last visit is around Oct 10,,, then the holidays etc!

Being in Fla. all the hospitals fill up with tourists until April. I wonder why they come some times!

I am really praying to get done before then. I have not lost anything so far.. month one. I do not want to get below my BMI of 40. I'll lose with the milk shakes I guess, but I'v heard if you go below- you can be turned down.. and if do not lose at all you can be denied,,dumb rules!

Glad to meet my peers, how are you doing Belinda! and Ms Love, I send you encouragement!

I wouldn't worry about dropping below 40. They want to know that you can lose weight. I didn't even start at 40--37.4 but with co-morbidities. All the best to you,

Melinda

[fromsleevedtome 50]

I am on BCBS Fed Standard. I started the end of April with a seminar at a Center of Excellence here in Eugene, OR. You complete an 18 to 20 page questionnaire about your history of obesity and your medical history as a whole. Then they will call you for a consult appt. Mine was the end of May. Went really well. My BMI was 37.4 and I have several co-morbities. After the MD appt, I met with their insurance co-ordinator who informed me that BCBS requires the following: 1) a documented weight history showing obesity for two years 2) documentattion of any weight loss attempts you made within the previous calendar year before you met with the surgeon--just a brief statement 3) three months of consecutive nutritional counseling. 4) screening by a psychologist.. The MD may send you to various specialists ie: cardiologist depending on your age, gastroenterologist for endoscopy, visit with your primary care to establish their support, perhaps a sleep specialist to rule out sleep apnea, perhaps an orthopedic consult. The consults will vary from patient to patient. After you complete all of the above, they (surgeon's office) will send your records to BCBS (usually by fax). My ins lady said it takes one to two business weeks. If everything is in order, it is usually approved very quickly and then they will schedule you within that month. Oh, one last thing, the surgeon requires that you lose 5-10% of your weight. before pre-op.

I hope this helps. Feel free to contact me if you have further questions. I have one more nutrion session then mine should be ready to go to BCBS. Hoping for surgery the end of Sept or so.

Melinda

This information is very helpful, thanks!

I appreciate everyone who responded and look forward to chating with you all throughout our journeys. You guys are a great source!