HELP ! Please

[MRS.BYARS 6]

IF I HAVE MEDICAL AND BLUE CROSS.DOES ANYBODY KNOW WHAT THE PROCESS IS AND HOW LONG IT TAKES. FOR THE GASTRIC SLEEVE

[ISleevedIt 380]

I think you need to check with your insurance since it varies from company to company. good luck.

[MRS.BYARS 6]

I think you need to check with your insurance since it varies from company to company. good luck.

K thanks

[SpaceDust 585]

It's definitely not something that anyone here could really tell you - it depends on your company (if your insurance is through a company's plan), your location (some states have insurance regulations that require coverage of certain conditions and others do not), what your factors for weight loss are (BMI, co-morbidities like diabetes, sleep apnea, etc) and so on. Your insurance company should be able to tell you if you're covered or if there's an exclusion, and what you would need to do to be approved. Also, depending on who you go through for your surgery they quite likely have an insurance coordinator who can give you the lowdown on what is likely to be the case. If you or your spouse have your insurance because of working for a large local company then the likelihood is that the insurance coordinator has had to deal with your insurance before and can help you figure out how to jump through all the hoops. Best of luck!

[MRS.BYARS 6]

It's definitely not something that anyone here could really tell you - it depends on your company (if your insurance is through a company's plan)' date=' your location (some states have insurance regulations that require coverage of certain conditions and others do not), what your factors for weight loss are (BMI, co-morbidities like diabetes, sleep apnea, etc) and so on. Your insurance company should be able to tell you if you're covered or if there's an exclusion, and what you would need to do to be approved. Also, depending on who you go through for your surgery they quite likely have an insurance coordinator who can give you the lowdown on what is likely to be the case. If you or your spouse have your insurance because of working for a large local company then the likelihood is that the insurance coordinator has had to deal with your insurance before and can help you figure out how to jump through all the hoops. Best of luck![/quote']

Thanks

[makemyownluck 785]

once your surgeon submits a pre-auth, the insurance company should respond within 30 days. but you have to check with your carrier to see what their requirements are. I started this process last year with H.M.O and found out they require 18 months of supervised diet. I switched to PPO as of Feb 1st and I'm already doing pre-op testing and will set a surgery date on my next visit - the PPO doesn't require the diet, even though the insurance was with the same company (BCBS), just different plans.

typically, to be approved, you need:

-BMI 35 or more plus 1 comorbidity (blood pressure, cholesterol, diabetes, sleep apnea, arhritis, etc)

OR BMI 40 or higher

-psych eval to confirm you don't have any mental d/o that would stop you from following post op advice

-documentation from your PCP saying they recommend/clear you for surgery

-dietitian counseling

-supervised diet - some plans don't require any diet, some plans can required up to 2 yrs.

your carrier can tell you exactly what their requirements are. Or, depending on the state, they might have their medical policy online. I have BCBSIL PPO and their requirements are online for anyone to see.

As far as how long, that's gonna depend on the requirements and how quickly you can book appointments for all the requirements pre-op. Then when you see the surgeon, they'll send you for a bunch of tests too (that's the stage I'm in).

Good luck!

[DebDUtah 67]

The only sure way to find out is to call the number on the back of your insurance card and ask to speak to Utilization Review. Those are the people (nurses) who review each and every submission for coverage of these types of procedures. They will be more than helpful as they do not like getting incomplete packages anymore than we like getting denied.

good luck

[MRS.BYARS 6]

once your surgeon submits a pre-auth' date=' the insurance company should respond within 30 days. but you have to check with your carrier to see what their requirements are. I started this process last year with H.M.O and found out they require 18 months of supervised diet. I switched to PPO as of Feb 1st and I'm already doing pre-op testing and will set a surgery date on my next visit - the PPO doesn't require the diet, even though the insurance was with the same company (BCBS), just different plans.

typically, to be approved, you need:

-BMI 35 or more plus 1 comorbidity (blood pressure, cholesterol, diabetes, sleep apnea, arhritis, etc)

OR BMI 40 or higher

-psych eval to confirm you don't have any mental d/o that would stop you from following post op advice

-documentation from your PCP saying they recommend/clear you for surgery

-dietitian counseling

-supervised diet - some plans don't require any diet, some plans can required up to 2 yrs.

your carrier can tell you exactly what their requirements are. Or, depending on the state, they might have their medical policy online. I have BCBSIL PPO and their requirements are online for anyone to see.

As far as how long, that's gonna depend on the requirements and how quickly you can book appointments for all the requirements pre-op. Then when you see the surgeon, they'll send you for a bunch of tests too (that's the stage I'm in).

Good luck![/quote']

Thanks thats really helpfull

[MRS.BYARS 6]

The only sure way to find out is to call the number on the back of your insurance card and ask to speak to Utilization Review. Those are the people (nurses) who review each and every submission for coverage of these types of procedures. They will be more than helpful as they do not like getting incomplete packages anymore than we like getting denied.

good luck

Thanks im going to do that asap