Submitted to Blue Shield of California!

[lolarose13 147]

Now the waiting is on. I submitted all the paperwork to get a conversion from lap-band to sleeve. I did everything they required and I pray that everything goes well! My only concern is my BMI. It is 35.5 BMI but they need only 1 commorbities (I have GERD, PCOS, Diabetes type 2, depression, anxiety, and high cholesterol). I hope this is enough for them

Prayers are super appreciated! I will keep you posted.

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[lasmith0802 67]

Good luck

[Tina4heath4ever 27]

Good luck!

[2goldengirl 2,076]

Which medical group are you with? The diabetes will be the comorbidity that counts.

[lolarose13 147]

I have BS of California PPO Plan (through trinet)

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[SusanB55 89]

Hi there, my husband and I have BCBS Fed and we were both approved. Hubby had bmi at 38 with diabetes and other comorbidities and I had bmi of 38 with only sleep apnea. Hubby is a newbie....but i, like you, was a revision. The band was problematic for 10 years but finally decided to jump thru all the hoops. We actually switched from another insurance during open season because the insurance gal in the office said bcbs was the best for approvals of bariatric. Good luck!

[2goldengirl 2,076]

PPO doesn't go through a medical group, so Blue Shield will look at your request directly. As long as you meed revision criteria, you should be good!

[lolarose13 147]

Still waiting. I called BS of CA and according to them, they haven't received any records from my doctor. The insurance rep called my doctor's office last Wednesday to verify and gave them their direct fax number to resubmit the records, but as of last Friday, the insurance was still waiting to receive the records, Sigh.

I'm hoping that this was just a mixed up and the records are submitted but not showing in the insurance's system, otherwise I lost an entire week

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[DSLdiversity 70]

I feel your pain. I'm waiting as well and lost a week because three months ago my psych evaluation was never added to my file

PhDiversity

[lolarose13 147]

New update:

So after hours of taking back and forth with the Insurance and doctor's office, I finally understood what happened with my records (they submitted more than a week ago, but nothing was filed with my insurance until today)

So my doctor's office sends everything to a "predetermination" departament of Blue Cross Blue Shield to verify (in written) that I have coverage for bariatric surgery. This predetermination process is voluntary, but I guess my doctor thinks is worthy, so they "submitted" to the insurance just get a determination of benefits. This single process can take up to 2 weeks. Once this departament says ok to the coverage, that's when they finally send the records to my actual insurance for precertification.

Gosh, I wonder why they didn't explain this to me from the beginning. So be aware that this is a common practice, so if your doctor takes this route, it will take much longer than what your own insurance told you.

Finally, my insurance received the predetermination (benefits only) and records today. Praying for an approval!

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Edited May 24, 2016 by lolarose13

[lolarose13 147]

So i just called and my insurance said that my revision has been approved!!!!!!!! PTL! I'm still in shock and waiting for the official call from my doctor.!

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[SusanB55 89]

Congrats!! Finally you get the answer you were waiting for!

[Deletemyacct 39]

So i just called and my insurance said that my revision has been approved!!!!!!!! PTL! I'm still in shock and waiting for the official call from my doctor.!

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That's awesome! Congrats! I have the same insurance. Gives me hope!

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