NC BCBS Insurance-What are their pre-requisites?

[deew57 11]

I went to a seminar in 2010 and had my surgeon visit scheduled. I was so excited! The week before my appt my fiance had a seizure and was found to have a brain tumor. I dedicated all my effort to see him thru his health crisis and put my WLS to the back burner. To make a long story short, he died after fighting cancer for 5 months. In my grief & dealing with his greedy family, I gained 40 more pounds over the next 2 years. There is a lot I want to accomplish before I get any older, plus my knee pain is getting worse-hence WLS. I have BCBS Gold thru employer and will go to a new seminar as required on the 20th (this wk). What can I expect BCBS to require--psych eval, nutrition eval, cardio clearance (had holter done a couple of weeks ago to test equipment at my office)?? Any info will be greatly appreciated!! .-)

[xochtlem 54]

I'm so sorry for the loss of your fiancé...I can only imagine how hard it must've been dealing with such an ordeal. ❤️

I'm not familiar with NC BCBS specifically, but it's pretty standard of insurance companies to require a psych eval, cardio and pulmonary clearance, and most require that you've done some type of non-surgical weight loss program for anywhere from 3-6 months depending on the plan.

I'm just starting the process myself and have Anthem BCBS, which requires 6 months. Thankfully I have documentation of my previous efforts, so maybe it will cut down on the wait to get it done.

You should try calling your insurance company to ask about the benefit and what they require. They'll likely refer you to documentation of their policy on WLS, which spells out all the reqs.

Good luck!

[deew57 11]

What type of efforts? I tried Slimfast last summer, with so-so results until I stopped. I have not tried any of the new weight loss drugs as my physician did not have faith in them. My Gyn Dr. is so supportive, as is my Ortho Dr. who happens to be Chief of Staff at the hospital I may be having my surgery at. Both will do letters & provide health documentation to support the surgery. I guess I will sit down with the Surgeon's coordinator after the seminar Wednesday as NC BCBS has had 'news-worthy' problems lately, and getting on the phone with them is time I do not have.

[xochtlem 54]

It depends on your plan. Some I've heard accept a narrative from your PCP stating that you've been under his/her care, others may require you participate in a medically supervised weight loss program, along with records of each visit weight lost, etc.

You just have to check with your plan for specifics. It's good to know before you go to the consult.

[Gg783 0]

I have BCBS NC and I am scheduled for surgery on 1/26. It depends on your plan but I didn't have a medically supervised diet or prerequisite other than my BMI level since I did not have any comorbidities. I actually was referred by my pcp. I received my surgery date at my first appointment back in October. I have to follow my weight management centers guidelines but that was it. You should be able to look up your specific plans requirements on the website. I am sorry for your loss.

[WalkOnWaking 139]

Keep in mind, its not the insurance carrier, but the plan that they are administering.

I had a BCBS policy last year when I had my surgery, and a good friend did also. My BCBS plan had a 6 months supervised weight loss visit requirement as part of their medical policy. Mental health evaluation, and starting BMI of 35 due to my comorbidities (would have been 40 if no comorbidities).

My friend had surgery last summer, but was self-pay in Mexico. Her plan, even tho the same BCBS policy in the same state, EXCLUDED bariatric procedures. My employer and her employer did not purchase similar plans with BCBS. It's all in what the employer wants to pay for (for those that have employer health benefits).