Experiences With Blue Cross

[shonda1536 10]

This is my insurance carrier, can you guys give me input on getting the surgery approved by them? Waiting period and requirements such as dr appts and all, thanks in advance!

[donna12 742]

I have BCBS-MI but live in KY (my ex-hubby's policy) anyway, there is a 6 month dr required diet unless your BMI is over 50 then they waive that. I started this about 3 and half wks ago and I haven't gotten any EOB's yet so I'm not sure how it will pay on Psych visit, sleep study, surgeon's appt, etc. Hopefully it will only cost me 20%. My surgery is scheduled for June 20th since my BMI was 52 I didn't have to wait the 6 months. I start my pre-op diet next week. My journey is just beginning. Good luck on yours.

Donna

[slp640 12]

I have bcbs of IL. I live in Texas. I had to do 6 month dr supervised diet and psyc test. You have to have bmi of at least 40. If under you have to have 2 comorbidities. I had 2 doctors the forst office dropped the ball so to speak but the second turned it in and I was appproved in 13 days. My surgery is scheduled for June 25th. So good luck to you.

[MdGardengirl 18]

I have BCBS of Maryland and I had to do 6 mos of supervised diet, psych test, pulmonary, sleep study and my doctor's blessing! Quite a bit involved, but it's all good because you have time to get into the diet mentality you are going to need for the rest of your life living with the band.

The supervised diet can't just be you saying you are on a diet. It has to be something like Weight Watchers, Jenny Craig, Medifast. I did Medifast. I just kept a graph of my weight and inches lost. They accepted it. Also, I had to stay on the same diet for at least 3 months and then could change to another one for 3 months, or stay with the same one for 6. But not 4 months/2months. Weird, but make sure you call your insurance company and get as much info as you can about their rules.

My surgeon's office coordinated pretty much everything. But don't depend on other people. Follow up with BCBS just in case! From my first visit with the Surgeon to surgery date was 8 months.

Good Luck on your Journey!

[cmoody821 44]

I have Anthem BCBS and a BMI of 40. I only had to have a psych evaluate, blood work, pulmonary function test and EKG.

[honk 780]

Anthem Blue Cross of NY. Approved in 2 weeks. No diet period. In my experience it is was my surgeon who required specific tests ect. Requirements from your insurance really are about your employers policy says. You should call your insurance and ask what their requirements are.

[brunettey22 3]

I have bcbs of al. I had to do a required 6 month supervised diet with my pcp. I had documentation from my ob/gyn dr saying that I had been overweight for a number of years prior to this. I was on the lower side with my bmi so I had to have a comorbidity and I didn't really have anything major I had elev cholesterol once and I had an instance of high blood pressure. Over all I was fairly healthy. I do have some mild back pain caused by weight gain. I just followed a reg diet and that was monitored by my pcp. I was approved with bcbs within 3 days! I will get my surgery June 12!!!!

[Cocoabean 430]

Call the member number on your card. There are different BC policies out there, your best bet is to call or look it up online. I have BCBS California Access H M O. All of the requirements were spelled out online.

[lolitawantsaband 45]

I have BCBSIL and I didn't need a 6 month supervised diet I need a psych eval and a bmi of over 40 and I also have comorbidity's. My surgeon require most of all the tests that you see below. As you can see it doesn't take long to complete yet it's still a waiting game.

[NoMoBand 278]

BCBS of New Mexico here. 3 month nutritional consult, psych evaluation. Paperwork submitted and was approved in 3 days. Strange how all BCBS insurance have different requirements from state to state.

[shonda1536 10]

Thanks for the input, it seems it depends on what bcbs you have in the certain state. I have bcbs ma and its an epo. It's an awesome plan as far as other services I was wondering how flexible it is regarding a weight loss surgery. I personally don't want to do the diet... I've tried SO MUCH that doesn't work. My gyn even had me on this weekly supervision weight loss program and it didn't work smh! Thanks for y'all help

[shonda1536 10]

Thanks for the input, it seems it depends on what bcbs you have in the certain state. I have bcbs ma and its an epo. It's an awesome plan as far as other services I was wondering how flexible it is regarding a weight loss surgery. I personally don't want to do the diet... I've tried SO MUCH that doesn't work. My gyn even had me on this weekly supervision weight loss program and it didn't work smh! Thanks for y'all help

[Cocoabean 430]

Thanks for the input' date=' it seems it depends on what bcbs you have in the certain state. I have bcbs ma and its an epo. It's an awesome plan as far as other services I was wondering how flexible it is regarding a weight loss surgery. I personally don't want to do the diet... I've tried SO MUCH that doesn't work. My gyn even had me on this weekly supervision weight loss program and it didn't work smh! Thanks for y'all help[/quote']

If you did that diet for six months and checked in once in each month, that should qualify. Most companies that require a diet want it within the past two years. I used weight watchers records.

[shonda1536 10]

**update** so I called my insurance company and I definitely meet the criteria, they emailed me over some specifications. Just waiting on this slow moving dr office. Trying not to be impatient but I'm thinking about trying another dr

[shonda1536 10]

Thanks Cocoa! I'll make sure to tell the surgeon to request those. She put me on that program because I wanted some adipex and since I have high blood pressure she refused and tried the diet instead :-\