no precertification for bc/bs

[Liciwiedner83 0]

Ok I just got got off the ohone with the lady from bc/bs and she told me that they don't do precertification for the lapband. What you do is have it done and then send it in to see if they'll pay for it. So what is the likely hood of them paying for it? If I do everything they ask, meet everything they want me to meet. They told me that it is covered if its deemed medically necessary. Has anyone ever dealt with them before, with this?? Thank you

[chubbola 0]

which bcbs do you have?

[NVgirl 2]

It all depends on your BC/BS. I have Anthem BC/BS HMO - I had to jump through the standard hoops, but was approved within 24 hours of submitting insurance. Took me 3 months from my first seminar to approval... surgery in less than 6 weeks now!

[chubbola 0]

It all depends on your BC/BS. I have Anthem BC/BS HMO - I had to jump through the standard hoops, but was approved within 24 hours of submitting insurance. Took me 3 months from my first seminar to approval... surgery in less than 6 weeks now!

this makes me happy to hear! i also have anthem...and i'm waiting for them to receive my papers. they were mailed over two weeks ago and anthem 'never got them' so my bariatric clinic faxed them yesterday. i'm so nervous for the final 'yes' even though they verbally approved it if it was 'medically necessary'...love to hear from you!

thanks

courtney

[ReneBean 3]

They may not do precertification - but they may provide a pre-authorization that they agree the surgery is "medically necessary" for you.

Those insurance agents can be tricky. Personally, I wouldn't want to find out after the fact that insurance will not pay...

[Roxie1951 0]

I have bc/bs Georgia. I had to jump through several hoops, but was notified that they have approved my surgery. It took over a month for them to decide, but none the less I got approved on the first time. That is so rare.

I'm excieted and scared at the same time. I start all my pre-op testing next week.

Good luck

Roxanne

[Liciwiedner83 0]

I have BC/BS Federal employee Benefit plan. I just don't understand if they cover it, why they won't preapove it, or what I should do.

[Alexandra 55]

I have BC/BS Federal employee Benefit plan. I just don't understand if they cover it, why they won't preapove it, or what I should do.

You may have a type of plan known as "indemnity," or a PPO. WIth these plans--which are generally considered to be the best type of plan to have--nothing requires pre-approval or precertification. All claims are based on the standard of whether the treatment is medically necessary. That may sound scary, but the essential truth of these plans is that they generally take the doctors' word for what treatment is necessary. That's why they're considered good--they don't try to second-guess the decisions of medical professionals.

If you really want reassurance, ask your doctor if he's had experience with your type of plan. I'll bet he'll tell you that you have nothing to worry about. I know the docs at my practice love the BCBS plans for precisely this reason.

[Liciwiedner83 0]

I really hope that your your right going in to this not knowing if they will pay for it is a lil bit scary. But I'm hoping for the best!

Thanks for ya'lls help

[edna 0]

Hey

I am sort of have the same problems with bc/bs, but I understand if I submit a letter to them letting them know how important it is for me to have the surgery, they will more than likely approve. I problem is, I need a sample letter from someone who has written a letter to the insurance co. requesting the lab-band surgery and how important it is to my health.

:clap2:

[BlueTattoo 43]

Well, i talked to the doctors office again. THey said that i had to have 6 months recorded dieting history from a doctor. Within the past 2 years... and what do u know .. Mine was 2.3 years ago so they wont take that. So i have to do that all over again , but they haven't submitted my request to the insurance company yet. Should i call the insurance company and see if they have pre certifications? I have PPO BCBS and when i talked to the Insurance rep the first time she never mentioned any requirements.

[marie 0]

I had the exact same thing with BCBS. I didn't want to gamble with $15,000 surgery in case after the fact they would not pay. I was able to change insurance since my hasband has several policies available at his work. It did add about 6 months to my qualification time.

I argued with BCBS and sent them letters and I still got the same answer to have the surgery and then it would go to a committee for approval.

[BlueTattoo 43]

well i called bcbs they said i could try and sumbitt a letter stating that i had medical history but it was too old . and see if i can get it approved quicker, if not i have to do the diet thing for 6 months. My bmi is at 42 and for bcbs to accept me it has to be 40+ so i'm wondering if my bmi goes down after the 6 months of dieting if i will still be qualified.