BCBSTX

[Mburk72 13]

Does anyone have bcbs and had to go through the approval process. I have a band and want to revise it to a sleeve. I've had nothing but problems with the band and can't get more then 3.5cc before I start vomiting. I am 185, with a BMI of 35. I have thyroid disease, borderline pre diabetes..

How long does it take for an answer, I hope they don't say no, I can't imagine why they would. Nervous! It's been a week since claims were submitted.

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[SusanB55 89]

Are you waiting for your surgery approval? My husband and I have BCBS Fed and it was submitted to insurance on April 7 and we received the approval letter on April 13. We were surprised it came so fast. I have heard some BCBS patients hearing within 48 hours and others 3 weeks. We were super nervous too!

Like you, I have a band and am going to my last NUT appt this Thursday. I hope I am approved as well for the sleeve. My husband and I were hoping to be going through this together. For 10 years we have been on different eating schedules due to my band and all the difficulties it presents. There is more to prove to the insurance for a revision. Did your surgeon tell you that the band and port would be removed in one surgery and then the sleeve would come later on? My surgeon told me this but when he saw how upset I became he said he would see how it looks when he goes in and if it looks safe to do the sleeve, he will. So I won't even know until I wake up if I am sleeved or not.

[Mburk72 13]

Are you waiting for your surgery approval? My husband and I have BCBS Fed and it was submitted to insurance on April 7 and we received the approval letter on April 13. We were surprised it came so fast. I have heard some BCBS patients hearing within 48 hours and others 3 weeks. We were super nervous too!

Like you, I have a band and am going to my last NUT appt this Thursday. I hope I am approved as well for the sleeve. My husband and I were hoping to be going through this together. For 10 years we have been on different eating schedules due to my band and all the difficulties it presents. There is more to prove to the insurance for a revision. Did your surgeon tell you that the band and port would be removed in one surgery and then the sleeve would come later on? My surgeon told me this but when he saw how upset I became he said he would see how it looks when he goes in and if it looks safe to do the sleeve, he will. So I won't even know until I wake up if I am sleeved or not.

My doctors office submitted my documents to bcbs last week on Wednesday the 13th, so I'm waiting to see if they will approve the band removal and sleeve revision. My surgeon wanted to do it in two procedures, but didn't want to chance the band being removed and then them not paying for the rest, so it was submitted all together in one procedure. I'm a surgical assistant and have assisted in many of these cases, so I know the ins and outs of the case. The only difference in one procedure and two is when you so both steps in one procedure your raising the risk of a leak, BUT the raised risk is still very low, so I'm not worried about that risk. When surgeons do it in one procedure, they just use a larger staple line, and reinforce it with suture. I don't want to go through two procedures, two recoveries, be put under anesthesia twice, have to take off work twice..

Just waiting on insurance, its making me a nervous wreck

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[SusanB55 89]

I was a nervous wreck for my husband's case. We knowingly submitted with only 2 NUT appts because the office had totally goofed up when they set up all his appointments. When I called bcbs, they told me that a dr supervised appt could count as a NUT appt as long as the documentation supported it. So I said, let's try it. I was so thrilled it was approved! He has almost every co-morbidity so that wasn't an issue.

Thank you for explaining that to me. My doc is super cautious and was talking about leaks and depending on the 'rind' (?) Would determine whether or not he would do both. I guess we will be submitting on me after my appt on Thursday,. I will then be in the same situation as you. Gulp! I have to pay two surgeon copays, do you? Ugh. $200 each. And times 2 people, lol.

My husband reminded me that the letter we received for him was actually dated April 8th, one day after it was submitted! I was too scared to call to check know the status but maybe you should call tomorrow instead of waiting for the letter.

Please let me know what insurance says! I'm rooting for you.

[SusanB55 89]

Besides your BMI at 35, do you have any of the co-morbidities outlined by BCBS? I have a higher BMI than you plus sleep apnea. I know that 35 is the minimum BMI to qualify but you need another medical problem, according to them.

[Mburk72 13]

Besides your BMI at 35, do you have any of the co-morbidities outlined by BCBS? I have a higher BMI than you plus sleep apnea. I know that 35 is the minimum BMI to qualify but you need another medical problem, according to them.

I have thyroid disease, I'm pre diabetes, my insulin levels are high, and have sleep apnea. I have no idea what was submitted to the insurance in the form of what they told them. I don't think I will have a problem with getting the lap band removed, but the revision is what I'm not sure about.

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[Mburk72 13]

Besides your BMI at 35, do you have any of the co-morbidities outlined by BCBS? I have a higher BMI than you plus sleep apnea. I know that 35 is the minimum BMI to qualify but you need another medical problem, according to them.

I have thyroid disease, I'm pre diabetes, my insulin levels are high, and have sleep apnea. I have no idea what was submitted to the insurance in the form of what they told them. I don't think I will have a problem with getting the lap band removed, but the revision is what I'm not sure about.

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Where are y'all from, I'm in San Antonio, TX.

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[SusanB55 89]

I'm in Tucson, AZ

[kaitlynm 335]

I have BCBS TX and it took them 21 days to give me approval. My BMI was 49 however so it was pretty black and white. I don't think they will count the thyroid as a comorbidity because the surgery won't effect that. The diabetes and the sleep apnea should get you through. They require a BMI of 35 with 2 cormorbidities, or a BMI of 40. I'm from Houston.

[Mburk72 13]

I have BCBS TX and it took them 21 days to give me approval. My BMI was 49 however so it was pretty black and white. I don't think they will count the thyroid as a comorbidity because the surgery won't effect that. The diabetes and the sleep apnea should get you through. They require a BMI of 35 with 2 cormorbidities, or a BMI of 40. I'm from Houston.

Because my surgery is a revision, removing band, and revising to sleeve Bcbs has different requirements then when you originally have a procedure. I know I won't have a problem with insurance for the removal, but the revision I'm just not sure, its only been a week and I'm already tired of waiting for an answer

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[SusanB55 89]

Call BCBS this morning! They may have a decision.

[Mburk72 13]

Call BCBS this morning! They may have a decision.

I called, they said it's still being put into the system and they have 30 days, unless your office submits it as urgent, ughhh

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[SusanB55 89]

Call BCBS this morning! They may have a decision.

I called, they said it's still being put into the system and they have 30 days, unless your office submits it as urgent, ughhh

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Oh crap. That really, really sucks. I feel for you. I'm a very anxious person by nature and a total worry wart. And our cases, being revisions, are a bit more complex and expensive which i am sure bcbs isn't quick to approve. It may be a longer wait for me too and not so fast like my husband's.

[Mburk72 13]

Call BCBS this morning! They may have a decision.

I called, they said it's still being put into the system and they have 30 days, unless your office submits it as urgent, ughhh

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Oh crap. That really, really sucks. I feel for you. I'm a very anxious person by nature and a total worry wart. And our cases, being revisions, are a bit more complex and expensive which i am sure bcbs isn't quick to approve. It may be a longer wait for me too and not so fast like my husband's.

Update, recalled bcbs today in the afternoon, got a much nicer operator, she apologized for it taking so long and said give them another few days and I should have a answer by next week, now that's more like it, even if that isn't true, its at least what I want to hear.

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