Approved! (Offering Help also.)

[Nylaj 45]

I am approved.

I go for my pre-op appointment on August 18th.

Then one month later, I will have it. Sept 17th cannot get here fast enough!

And for those wondering, I got approved in North Carolina with the State Hlth Plan at BlueCrossBlueShield.

Btw: I work with insurance companies all the time with getting these types of cases approved.

If anyone ever needs any or guidance, let me know!

I will try to help you all.

Have a great day!

[samelton68 64]

Congrats!

[Nylaj 45]

Thanks!

I am nervous, but excited!

Congrats!

[The Candidate 3,215]

Congratulations on your approval and surgery date!

[jennolsen 140]

Congrats! I got my approval today and am hoping for surgery near your date. Good luck to you!

[taweedeegirl 68]

do u know y most claims for these surgeries get denied ?!

[northmsgirl 3]

Any experience with federal plans administered by Cigna (I have SAMBA coverage)?

[theatrejo 29]

@@Nylaj My BCBSTX has an exclusion for Bariatric and won't TOUCH it! I am having to pay cash. Boo. I think they will pay for my stress test but that is about it. They suck.

[Nylaj 45]

do u know y most claims for these surgeries get denied ?!

We did a Survey recently with a bunch of insurances & it came back that most still feel it is kinda like 'cosmetic'. Even though it's not. They think that a person can lose weight on their own & shouldn't need medicine to interfere, but yet they want you to turn to medicine to lose weight. Which makes no sense, right? Right.

Also, it is ELECTIVE. Meaning, it is NOT medically necessary even though your BMI is over 40 & you have a bunch of comorbidities. You can treat your other issues with medicine, which is a lot cheaper than weight loss. But the insurance companies fail to realize, you might be able to quit half of those medicines, if you lose all the weight.. Which means? In the long run, they won't be paying for more claims.

You know how some insurances want you to go through 3 - 6 months of weight loss training with a nutritionist or a weight loss doctor, well say you do what they say & lose 30lbs. But you still get denied. Why? Because you lost weight following the plan, which means, you can lose weight on your own. So why should they cover to pay the $20,000 surgery?

Also, a lot of patients fail to realize, your insurance has to have it as a COVERED BENEFIT. Most people just assume that because they have insurance, they should pay. That is not the case. You should know your insurance policy like you know your social security number. You should study what they say & how they word things..

Any experience with federal plans administered by Cigna (I have SAMBA coverage)?

Yes, we had a few patients approved with Cigna/Samba Coverage.

What is happening with your case?

You can private message me if you want.

[Nylaj 45]

@@Nylaj My BCBSTX has an exclusion for Bariatric and won't TOUCH it! I am having to pay cash. Boo. I think they will pay for my stress test but that is about it. They suck.

I am assuming that it isn't a covered benefit under your plan?

We did a few BCBS Texas patients last month. But it was covered by their plan.

Always read your policy & the underlying rules & regulations.

[nesheag101 8]

@@Nylaj I have also have BCBSNC for teachers and state employees...1st consult with doc on Wed. Praying for approval!

[LessOfMe0503 157]

I have NC BCBS for teachers and state employees and I had no problem getting my surgery covered. The lady who does insurance at my surgeons office said the lady she talked to at the insurance company didn't know the plan. They made a change in their policy and the rep didn't even know. I'm about 6 weeks out from surgery.

[nesheag101 8]

I have NC BCBS for teachers and state employees and I had no problem getting my surgery covered. The lady who does insurance at my surgeons office said the lady she talked to at the insurance company didn't know the plan. They made a change in their policy and the rep didn't even know. I'm about 6 weeks out from surgery.

That gives me hope!

[nesheag101 8]

I have NC BCBS for teachers and state employees and I had no problem getting my surgery covered. The lady who does insurance at my surgeons office said the lady she talked to at the insurance company didn't know the plan. They made a change in their policy and the rep didn't even know. I'm about 6 weeks out from surgery.

That gives me hope!

My BMI has always been at 40-41. I did loose a few pounds and it put my BMI at 39 and some change and of course I am back at 40. I don't have any co morbidities other than Asthma although I am showing signs for sleep apnea.

[LessOfMe0503 157]

I have NC BCBS for teachers and state employees and I had no problem getting my surgery covered. The lady who does insurance at my surgeons office said the lady she talked to at the insurance company didn't know the plan. They made a change in their policy and the rep didn't even know. I'm about 6 weeks out from surgery.

That gives me hope!

My BMI has always been at 40-41. I did loose a few pounds and it put my BMI at 39 and some change and of course I am back at 40. I don't have any co morbidities other than Asthma although I am showing signs for sleep apnea.

I didn't have any comorbidities but my BMI was over 50.