Nice Chat With Customer Svc At Bcbs-tx

[Tif 2.0 141]

Yesterday afternoon, I was just bothered by the whole will they/won't they mind game of insurance approval. Now, I realize I can't even submit for another month. I have one more weigh in for my MSWL program requirement.

I called BCBS-TX yesterday and asked her if I had to use one of their Blue Center of Distinction for Bariatric Svc. She put me on hold and came back and said for Bariatric Surgery, no I don't. She told me that it is all up to the policy riders that each employer puts in the coverage. She said our insurance has that requirement for Organ Transplant, but not for Bariatric Surgery. So then I asked her to repeat the requirements so I could make sure I wasn't missing anything. (I'm not. YAY!) I told her that I was stressed out about not being approved and she said that for almost everyone that applies they are approved providing all the requirements are met. She said that 90% of the denials are based on missing paperwork and most of those are approved on the 1st appeal.

She was SUPER nice and patient and I realize that she's not the decision maker, but it did help put my mind at ease a little bit. I know I'm doing everything that I'm supposed to.

[Mel34 11]

Hey tiffini!

I have BCBS Federal and this post put me at ease, so thank you for sharing the information. they just submitted my paperwork this past Friday or Monday and I'm sooooo nervous! : (

[longer-life 139]

Good for you for calling your insurance. That was my very first step. Many people don't and put all their trust on the insurance coordinator at the surgeons office.

Also, did you find out what criteria they use to choose the Center of Distinctions? If they believe those places have higher standards, then you might want to consider them. My first criteria was that my surgeon had to be a Surgeon of Excellence. These Centers of Distinction might be Centers of Excellence. Best wishes!

[Tif 2.0 141]

I called my insurance in the very beginning too. Even before I went to the seminar. LOL!

The reason I'm not going with the center of excellence is purely economic. I will have to pay $3000 out of pocket if I go there, but if I go with the Surgeon I am going with, I will have no out of pocket expenses other than the psych eval and nutritionist. I'm going with a reputable company, just out of network and they can charge whatever they want and aren't held to provider contracted rates.

[longer-life 139]

I "only" had to pay a $600 fee. Fees in the thousands are crazy! Is that the only surgeon of excellence near you?

http://www.surgicalreview.org/

[Tif 2.0 141]

I "only" had to pay a $600 fee. Fees in the thousands are crazy! Is that the only surgeon of excellence near you?

http://www.surgicalreview.org/

There are 3 COE near me, but I will have to meet the $2500 deductible and then $500 out of pocket fee in order to use them. So I'm going with another surgical center and so far I have no complaints. The surgeon has been doing bariatric surgery for at least 10 years. In my view, it's no different than going to Mexico. LOL!