Anyone heard of a pre-service review to get "pre" approved?

[LMJLMJ 0]

I just called my insurance (BC/BS of CA Federal program) to talk to them about co morbidities (for a reminder, my BMI is 37ish and I have several "small" cormobities such as hyperlipidemia, prediabetes, infertility, and suspected PCOS (awaiting a call to be tested) but nothing really BIG) so anyways, I was telling her I wanted to know the criteria for approval because I don't want to have to pay the out of pocket expenses for the nutritional eval and other expenses, just to find out I don't meet the criteria.She said the surgeon can submit something called a pre-service review talking about medical necessity etc and my history and from there I basically will get a "pre" approval or denial w/o having to have the nutritional or psych eval yet. Also, she said those evals are not for them (the insurance) that they are requirements for the surgeon. I didn't know that..Anyway, does anyone have any info on a preservice review? Anyone heard of it? Thanks!

[ragdollx19 1]

My doctors office uses a place called AIGB who handles the preservice stuff for them as well as other doctors in the area. They took my medical history, current weight & measurments and all that so my doctors office could just file for approval. I have BCBS Federal Basic option and was approved in a few days. My BMI was 43 or something though.

On page 48 of our plan book it says you must have a BMI of 40 or above OR 35 or above with comorbidities.

I think they just have to submit your medical history along with diets and ect you have tried. Look on the internet for your area and see if there are any doctors groups that use a company to handle all of this for them or find someone who has done a Federal BCBS case since they started covering lap band in January.

Good luck!!

[LMJLMJ 0]

Thanks. I have basic option too...Hopefully my issues will be counted as comorbidities, I really, really hope the PCOS diagnosis works out...

[tanderson 3]

Anyway, does anyone have any info on a preservice review? Anyone heard of it? Thanks!

I haven't heard of it before. I would call the person that handles the insurance at your surgeon's office and get them to explain it.

Peace Out!

T~:hippie:

[Sandraabsomi 0]

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