Insurance Questions - BCBS of Alabama Specific

[DustyRider 0]

Hello all, I am new here and found this site after doing a search for someone who can give me some answers.

I have completed my 6 month MD monitored diet and have almost all paperwork in hand to submit to BCBS of Alabama to hopefully get approved. I only lack the Medical Clearance letter from my GP (and that's a whole 'nother story for later.) I hope to have that letter in hand on Monday.

My questions are these:

1. How long does it usually take the insurance company to make a decision?

2. What are reasons that they may reject me?

3. Should I personally call BCBS and speak with a representative before the paperwork goes in?

4. Any other advice to help my case with them??

The surgeon has set a tentative date of Nov 22 for my surgery - they believe that my approval will fly right through because of my co-morbidities. (sleep apnea - uncontrolled high blood pressure - etc)

I am just VERY nervous that all this work and what I've gone through for the last 7 months will be for naught if they reject my claim.

[Chasity Henson 4]

I also have blue cross and blue shield of AL and after my info was sent to them they still had not given us an answer in a week like the dr said they usually do. So i could not take the suspense any longer i called and asked them to look at my information to see if there were any notes on it. They said it has been approved but the letter had not been sent out yet. I am now waiting on my surgery consult date to find out my actual surgery date. I also called before to be sure that my out of pocket max for the year is $2000 like i was told and how much mine showed at that time. A very nice rep named Steve talked to me about it and looked for any exclusions on the contract. I don't think it will hurt if you want to call the insurance company and talk to them. I felt great and got a lot of information from the rep I got.

[Cynsayshun 10]

I also have blue cross and blue shield of AL and after my info was sent to them they still had not given us an answer in a week like the dr said they usually do. So i could not take the suspense any longer i called and asked them to look at my information to see if there were any notes on it. They said it has been approved but the letter had not been sent out yet. I am now waiting on my surgery consult date to find out my actual surgery date. I also called before to be sure that my out of pocket max for the year is $2000 like i was told and how much mine showed at that time. A very nice rep named Steve talked to me about it and looked for any exclusions on the contract. I don't think it will hurt if you want to call the insurance company and talk to them. I felt great and got a lot of information from the rep I got.

I have BCBS of IL and after all my paperwork was submitted by my Surgeon it took only 2 weeks for them to contact the surgeon with my approval. My out of pocket was $1200 and it had already been covered, so for my surgery I didn't have to pay for anything, so far the hospital bill alone was $70,000. That doesn't include the surgeon.. So in my case BCBSIL rocks!!!

[Chasity Henson 4]

Why in the world was it 70,000 dollars for the hospital bill? Self pay here is around 17,000.

I have BCBS of IL and after all my paperwork was submitted by my Surgeon it took only 2 weeks for them to contact the surgeon with my approval. My out of pocket was $1200 and it had already been covered, so for my surgery I didn't have to pay for anything, so far the hospital bill alone was $70,000. That doesn't include the surgeon.. So in my case BCBSIL rocks!!!

[DustyRider 0]

Why in the world was it 70,000 dollars for the hospital bill? Self pay here is around 17,000.

Thank you both for your replies, I'll keep you posted!

[Grider 92]

Evey state is diff,, just like you have to have $900,000 to buy a condo in NY, and only $50K in Tampa Fl.. so its the same with medical--

[Dawn200321 146]

They always charge more to the INS. Co then to a self pay patient...of course 70,000 seems like a lot for this surgery. But Grider is right...every state and every doctor is different

[Cynsayshun 10]

Why in the world was it 70,000 dollars for the hospital bill? Self pay here is around 17,000.

Well, I can't give itemized information, however, I was in the hospital for 2 days.. I had a couple of hernia repairs along with my band. Also I had the barium swallow test the next morning and some blood work done the next morning. Maybe there is a difference in the medical costs from up North vs Down South. I really don't have any other explanation. All I know when I viewed my BCBSIL processed payments on line, for the Vista Hospital the price paid was 70,000, maybe that includes the surgeons costs, because it is a Center of Excellence..

[DustyRider 0]

Got my Medical Clearance letter today and the surgeon's insurance girl sent it all off. Keep your fingers crossed for me! The insurance girl did send an email to me saying to expect to receive 2 letters from BCBS this week, the first a denial and second an approval.

[DustyRider 0]

Got my Medical Clearance letter today and the surgeon's insurance girl sent it all off. Keep your fingers crossed for me! The insurance girl did send an email to me saying to expect to receive 2 letters from BCBS this week, the first a denial and second an approval.

[tflitter 0]

Question- I am going to have BCBS (anthem) WI as of Jan 1. If it states in the plan that they do not cover weight loss programs or treatment of obesity, am I a lost cause? Was this included in your BCBS plan? I would assume that I do have comorbids- High cholesteral, hypothyroidism, mild asthma, depression, bordeline diabetic and family history for heart disease, with a BMI of 36.7.

I am so frustrated right now.

[1_Day_At_A_Time 0]

Hello all, I am new here and found this site after doing a search for someone who can give me some answers. I have completed my 6 month MD monitored diet and have almost all paperwork in hand to submit to BCBS of Alabama to hopefully get approved. I only lack the Medical Clearance letter from my GP (and that's a whole 'nother story for later.) I hope to have that letter in hand on Monday. My questions are these: 1. How long does it usually take the insurance company to make a decision? 2. What are reasons that they may reject me? 3. Should I personally call BCBS and speak with a representative before the paperwork goes in? 4. Any other advice to help my case with them?? The surgeon has set a tentative date of Nov 22 for my surgery - they believe that my approval will fly right through because of my co-morbidities. (sleep apnea - uncontrolled high blood pressure - etc) I am just VERY nervous that all this work and what I've gone through for the last 7 months will be for naught if they reject my claim.

Hi there! I too had BCBS of AL...and just played the waiting game myself. I had the 6mo diet, jumped through all the hoops. My doctor's office submitted and I didn't hear anything for a week. Being impatient and hating to wait, I called and spoke to CS. I felt a little silly, but they were very nice. They did not have any pre-determination on file at that time. I called back a few days later (since the doc's office said sometimes I can hear before they do) and found out I was rejected!

This really put me into a tailspin and I was pretty surprised. They said my doctor's office neglected to include a 3-year medical records documenting my weight. Since my deductible has already been met for the year AND my insurance is changing come 1/1/12, I was pretty desperate to get this solved quickly.

Since I don't have a regular PCP, I contacted my gyno's office and was able to obtain documentation. They resubmitted to insurance and a week later, I was approved!

I just got the news of approval last Monday and my surgery is scheduled for 12/1. I am beyond thrilled!

My advice to those waiting...it's terrible to wait, but keep your eye on the prize. Keep your head high and you will get there!!