Highmark BCBS

[tallow2102 16]

I have began my journey and so far have done my psych eval, I still have 4 months left of nutrition that my insurance requires. I am on the lower BMI scale, but do have pre-diabetes and some other weight related issues. I wanted to see what other people's experiences with Highmark has been like. I hate not knowing the outcome, my Dr. Seems to think it won't be a problem being approved, but the fear of the unknown is still there:)

[TMG1980TMG 136]

I have Highmark BCBS--

BMI 45 at time of submission--

I had no other health problems

6 months supervised diet- lost 8 pounds total with a gain at one weigh in.

Psych eval

Endoscopy(required by surgeon)

Medical necessity/Clearance for surgery letter by PCP (including EKG and blood work)

Once submitted my request was approved in 4 days.

What is your BMI?

They are awesome- they have paid on all of my surgery related bills except psych eval!

Edited December 7, 2015 by TMG1980TMG

[Pillar2butterfly 391]

I have BCBS...no issues, got approval in less than a week. Paid all but 20%...my out of pocket total for copays, exams, tests and surgery was only $2k. Very clear cut on their stipulations. 6 month followed plan.

[animallover1247 249]

All of my documentation will be ready for submission on 12.21. Of course I have no idea how long it will take the surgeons office to submit it. I cab let you know how it goes (if I don't forget) I have Highmark BCBS as well.

[tallow2102 16]

My BMI is 35.9

[tallow2102 16]

12/21 is right around the corner!! Exciting! I hope it all gets approved for you????

[KristinaF 5]

I have Highmark BCBS as well. I am a band to sleeve revision. No problem with them at all. Completed everything that the hospital wanted me to do prior to surgery. Paperwork was submitted and approval came a week later. So far, insurance has paid for everything, but I got a bill from my hospital for ten grand, stating that my insurance is refusing to pay for the lap band removal. I told them that is wrong, I have two approval letters, have talked with insurance multiple times prior to surgery and have read my policy coverage front to back and sideways. There's nothing in there stated that for a revision, they will only pay to have 85% of my stomach removed, but they won't pay for my leaking lap band to be removed. That's part of the revision surgery. My band was leaking, it is physically broken, we have the fluoroscopy results to prove it.The girl I talked to looked into it and said that the coding it correct but it looks like it was misworded on the hospital's end. So, waiting for billing management to look into it and hopefully get it corrected and resubmitted to Highmark BCBS. We are switching insurance companies in January to United Health Care and my company decided to drop bariatric surgery coverage.

[Trish71 0]

Did you need to do a timeline letter to insurance explaining the band issue and why you need the revision to sleeve? I need to do one and am looking for ideas.