BCBS of Iowa anyone?

[jackie506 1]

Hello everyone. I was just wondering if anyone else has blue cross blue shield of Iowa and if they had the surgery did you have to go through a lot of hoops to get it approved? Denials before approvals? I am just starting this journey. Done a 6 month diet with my family doc 2 others times and succeeded with them just gained all the weight and then some back. Surgeon at seminar said if it had been over 2 years I should start again. So here I am again going to the doc monthly and all that hoopla.

I honestly think sometimes the reason for all of this is so that the insurance company can see how committed you are to pursuing this whole thing.

Oh well......that is another complaint for another night.

So I am now on weight watchers...yet again....and I am starving as I type. GRRRRRRRRRRR

Please give me any feedback you have in regards to this insurance. I am so afraid that I am going to jump their hoops and they are going to shoot me down. :angry

[TheLid 0]

I live in Washington, but my insurance is Wellmark BCBS of Iowa. I am also starting the process of getting all my stuff together to get aproved by the insurance. Have you checked to make sure that it is even a covered surgery with your plan? Mine is, but I have to show that I have tried other things first. I got my PCP to write a letter stating that I have a long history of diet and exercise and that it has not resulted in permanent weight loss. I hope this will be good enough, because I don't have a lot of doctor visits that focused on my weight.

Each plan is different, and I have found that every person you talk to at the insurance company will probably tell you something a little bit different, so write down the name of each person you talk to with the date and time. Good luck.

[jackie506 1]

Yes mine is covered. I was told by 4 people at BCBS of Iowa that you MUST HAVE a physician supervised diet within the 2 years prior to requesting approval for surgery. I have started that AGAIN because mine has lapsed and I have my consultation with the surgeon in 2 days. I am 2 months into the supervised diet and the surgeons office and my doctor say things are looking great and moving right along. I know it will still be a wait because of the insurance and all but I am getting excited. I am scheduled to get some of the pre op testing completed so that way that is out of the way also. Wish me luck and good luck to you to. Please keep me posted on how things are progressing for you.

[TheLid 0]

Are you through Wellmark? I am really nervous that the next person I talk to will say yes on the supervised diet. I don't want to wait! I don't want to pay for it myself either;) I hope all goes well for you.

[smriggs 0]

I have BC/BS of Iowa and my BMI is over 50 so I am working to get it down. They will pay for it only if it is less than 50 even though my surgeon has sent them piles of documentation from other places stating the results after 5 years are the same with lapband and RNY. It is frustrating because I am in this siutation because I cannot stick to or have trouble sticking to a diet and now here I am again in the same boat. So, my surgeon has me talking with the nutritionist ofr 3 months of dieting and then we shall see before he even submits anything. What's the point of doing it all knowing it will be denied.

[jackie506 1]

Are you through Wellmark? I am really nervous that the next person I talk to will say yes on the supervised diet. I don't want to wait! I don't want to pay for it myself either;) I hope all goes well for you.

Yes I am through wellmark. Just had my consultation today. Surgeons office told me that I need to finish my supervised diet, (3 more months) and then I should be set. I have been very proactive with this. I have talked with my family doctor and had him setting up the appointments and tests that they will need done for surgery. The surgeon told me today that is really helping because once I have the supervised dieet done I will have all my testing complete also. The surgeon won't even order anything until I am approved by my insurance because the insurance won't cover it if they haven't already pre approved the surgery before he orders all the testing. Makes it alot easier just to have my primary order these things for me.

[jackie506 1]

Yes I am through wellmark. Just had my consultation today. Surgeons office told me that I need to finish my supervised diet, (3 more months) and then I should be set. I have been very proactive with this. I have talked with my family doctor and had him setting up the appointments and tests that they will need done for surgery. The surgeon told me today that is really helping because once I have the supervised dieet done I will have all my testing complete also. The surgeon won't even order anything until I am approved by my insurance because the insurance won't cover it if they haven't already pre approved the surgery before he orders all the testing. Makes it alot easier just to have my primary order these things for me.

Oh yeah forgot to answer your actual question, yes BCBS of Iowa REQUIRES a 6 month supervised diet. No way around it. They will keep denying you until you have one.

[jackie506 1]

I have BC/BS of Iowa and my BMI is over 50 so I am working to get it down. They will pay for it only if it is less than 50 even though my surgeon has sent them piles of documentation from other places stating the results after 5 years are the same with lapband and RNY. It is frustrating because I am in this siutation because I cannot stick to or have trouble sticking to a diet and now here I am again in the same boat. So, my surgeon has me talking with the nutritionist ofr 3 months of dieting and then we shall see before he even submits anything. What's the point of doing it all knowing it will be denied.

I agree. If we could do this ourselves we wouldn't be seeking surgery. I was afraid the surgeon would require some weight loss as well but he doesn't. His requirement is that you not gain any more weight before surgery (he goes by what your weight was at your consultation). You can loss or maintain but CAN NOT gain or he will cancel the procedure. Makes sense I guess. Thank goodness it is summer now so it will be to hot to eat sometimes. Good luck on your diet. Keep me posted. We could both support one another through the waiting process.

[xgrl 0]

So I'm Starting Out and I also Have BCBS of Iowa My BMI is only 37 and i'm kinda nervous that they won't allow me to have this surgery I've been battling with the scale since i was a in 8th grade I was on Phenteramine from 2003 to mid 2006 I don't have one of the co morbities that they list in the policy but i do have others. I've been on just about every weight loss system that i could think of and afford. if you don't mind me asking what are your bmi's i don't mean to be rude but i'm wondering if anyone under 40bmi has been approved

[jackie506 1]

XGRL

My BMI is 47. My friend has a BMI of only 36 and she was approved. She has diabetis. She has been trying to get the surgery for a while but she only had 1 co morbidity. Now she has high cholesterol and they approved her because now she has 2 co morbidities. Am I the ony one or does that sound ass nine? They wouldn't approve it until her health became WORSE!!! I don't get it. Good luck to you and congrats on taking control now. Don't let them deny and then walk away. Keep trying!!

I haven't had surgery yet either but I am hoping by August. The surgeons office told me they don't think I will have any problem getting approved because of my BMI and I now have diagnosed sleep apnea and use a CPAP. I have 1 more visit for the supervised diet and then we will be submitting. I have already done my endoscopy, sleep study, psych eval, nutritionist, surgery consult, echocardiogram and now just 1 more month of the 6 month supervised diet. I have been very proactive in this persuit getting all of my testing done prior to even submitting. The surgeon told me that was great because I shouldn't have any waiting time once/if I am approved for surgery except for the 2 week liquid diet prior to surgery. Thank Goodness.

Good luck on your pursuit and keep us posted. I will post when/if anything new happens here.

[xgrl 0]

I completly agree with the fact that they want to wait for your health to get worse before they will allow you to try and reverse all the damage already done it's crazy i have some of the comortalitys but they aren't the ones on the BCBS website, so i don't know if they will work i've been reading on here that most people don't realize that they have sleep apnea so is it bad that i'm kinda hoping i have it so i can get on the right track to losing weight and changing my health in a good way... my seminar is on Tuesday the 19th and soon after that i hope to meet with the surgeon i'm gonna try to get my general practitioner to suggest a sleep study and get that done. I'll keep you updated i'm wishing we'll get approved!!! Heres Hoping Talk to you soon!

[jackie506 1]

Do as many tests as you can. My PCP ordered all of the tests that I have already done and BCBS paid. I was really nervous about doing them all pre approval because I read some where that one person done that and their insurance wouldn't cover the costs because they weren't approved. I personally didn't think that made sence since we have to do the testing to see if we have co morbidities.

[TheLid 0]

I just found out that I am approved! I haven't been on this site in a few weeks because I didn't really have anything to say, and I have just been too busy with school. I am so excited to be approved. They did not make me have a supervised diet. Maybe I just got lucky. Originally my Dr told me to wait to do the psych eval and all the other tests until I knew if the insurance would pay, then they sent in all of the other paperwork to the ins. THe insurance then said that they couldn't even make a decision without the psych eval. Once I found that out it took two and a half weeks to even get an appointment (that was just pure luck, because all of the other providers I could find were scheduling people out at least a month in advance). Once I passed the Psych clearance we faxed everything again to the insurance and of course they didn't get it. I think it is amazing that it takes a week for them to know if they have something or not. We re-faxed everything (this is the third time now) and I got approved in a few days. I think that the only reason they finally approved me so fast was because I was calling them almost every day for a few weeks. Not to mention my Drs office was calling. One lady even said, "I think I have talked to you about this before." My BMI is 47 and so far I don't have any of the co-morbidities on the list. I hope you all have good luck with the insurance.

[jackie506 1]

I just found out that I am approved! I haven't been on this site in a few weeks because I didn't really have anything to say, and I have just been too busy with school. I am so excited to be approved. They did not make me have a supervised diet. Maybe I just got lucky. Originally my Dr told me to wait to do the psych eval and all the other tests until I knew if the insurance would pay, then they sent in all of the other paperwork to the ins. THe insurance then said that they couldn't even make a decision without the psych eval. Once I found that out it took two and a half weeks to even get an appointment (that was just pure luck, because all of the other providers I could find were scheduling people out at least a month in advance). Once I passed the Psych clearance we faxed everything again to the insurance and of course they didn't get it. I think it is amazing that it takes a week for them to know if they have something or not. We re-faxed everything (this is the third time now) and I got approved in a few days. I think that the only reason they finally approved me so fast was because I was calling them almost every day for a few weeks. Not to mention my Drs office was calling. One lady even said, "I think I have talked to you about this before." My BMI is 47 and so far I don't have any of the co-morbidities on the list. I hope you all have good luck with the insurance.

Congratulations to you!!! I am soooo envious. I am finishing up my supervised diet. You are really lucky you didn't have to do it. BCBS told me they would not approve if a person doesn't do that. Lucky you!! Whens the big date? Where are you having it done?

[TheLid 0]

I live in Washington so I am having it done here by Dr. Fox. I don't have a date yet. I have to work out some things with my schedule first. Hopefully I will have a date by Monday. I know I really got lucky with not having a supervised diet. My Dr is very strict with pre and post op follow-up, so I will be on a supervised diet with him for at least the next year or two, until I reach my goal weight. Woohoo!! How much longer do you have before you can submit your info to the ins? I hope everything goes smoothly for you.