Approved! (Offering Help also.)

[Kaliahsings2u 13]

Is that PAI? I have the same insurance

[Kaliahsings2u 13]

I have preferred blue (PAI) of SC. Everyone I know was approved but I'm nervous.

[nesheag101 8]

I have preferred blue (PAI) of SC. Everyone I know was approved but I'm nervous.

Not sure of it is the same but I do share your nervousness! I go tomorrow for consult

[Nylaj 45]

You shouldn't have any problem if your BMI is over 37.

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

[nesheag101 8]

@@Nylaj had my consult yesterday BMI was ok. My issue now is I have not met any of my deductible so facing a lot of out of pocket cost up front versus them billing me.

[Nylaj 45]

Where are you having it done at?

UNC lets you pay slowly until your date. My surgery is on Sept 16th. Since July, I been paying something towards my deductible since then. Just paid the $700 ded off yesterday actually.

If you meet your deductible before your surgery, BCBS NC will pay more for your surgery & your oop will be less.

@@Nylaj had my consult yesterday BMI was ok. My issue now is I have not met any of my deductible so facing a lot of out of pocket cost up front versus them billing me.

[nesheag101 8]

@@Nylaj

I planned on having it at Lake Norman but looking at Presbyterian with Dr. Voellinger to weigh out my options. Wanted to have it in Salisbury since i live in Salisbury they are not Blue distinction hospital

[tmac1502 8]

I'm hoping to not have problems. I have Cigna (Great West) bariatric Center is waiting 30 days prior ti surgery date to do pre auth. My BMI is 53 & it is a covered surgery. I will feel so much better once it is approved!

[2016NewMe 61]

Hello so are you saying that it's best to stay at the weight while the process so I can get approved and not denied???

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.

[Natalie Alley Perkins 27]

I have BCBS of ky. My plan does cover me cause I called to dbl check before first appt. I have 3 co morbities BMI of 37.2.was filed last week. The INS lady in the office isn't very helpful. All she said is that my type of INS approved fast and should be scheduled for October. Have done all other tests

Edited September 15, 2015 by Natalie Alley Perkins

[sparker525 1]

I've been told that my Louisiana BC/BS plan does not cover it at all, ever. Is that true? Are there ways to get around that? Also, what companies do cover it? I'm thinking of buying a second policy with a other company that does cover the procedure but I don't know if that would work or even where to start. Thank you!!

Edited September 17, 2015 by sparker525