PA Highmark BCBS PPO Insurance- I need help!

[cls5186 23]

Hey all! I'm new to this community as well as to gastric sleeve surgery. I have been thinking about this procedure for months now, and finally after researching it, i've decided to go ahead with it. I contacted my insurance company, which is Highmark, BCBS of PA and this is what i've concluded is needed: BMI - over 40.

Age of 18 and over.

6 visits (1 visit per month) with my doctor, who will monitor my weight and exercise regime.

A psych eval.

A nutritionist visit.

Anyone know if there is anything else I need, or have left out? I need some help with this. Also, is it ONE visit to a nutritionist? Also, how will my doctor be "monitoring" my exercise? I can see weight, whether it increases or decreases each month.

I live in PA, so those are the specifics i've researched, anyone else have any input?

Help!

[becomingmandikaye 262]

Honestly, the best thing to do is call them and talk to them. But be aware that the reps can be wrong (mine were) and working with outdated information. Have the list of what you believe are the requirements and your source, and then just ask them.

[cls5186 23]

I called and they told me they would send me the info on it, days later I still haven't received it. But they read off to me exactly what I have listed. I'm still just so confused about it all.

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[marnie86meg 1]

Hi. I have Highmark BC/BS of PA. I had my initial consult on June 29th. I need to see a dietician for 6 consecutive monthly visits, 1 psych eval, start an exercise program and medical clearance from my primary physician. Other tests need to be done also prior to surgery, like a gastroscopy, bloodwork, chest xray and cardiogram. It's a process, but if you want something bad enough like myself you will adhere to the pre surgery requirements. It also gives you time to really learn healthy eating habits and prepare yourself for life changing surgery. Good luck with your journey and best wishes always....

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[cls5186 23]

Does your insurance cover the cost of going to dietician for 6 months? Is it the co-pay of $25 for the speciality doc?...this is all so confusing, the list doesn't say anything about all these tests that need done...and also was your initial consult with your primary physician or with a dietician? Thanks for your help

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[marnie86meg 1]

My initial consult was with the surgeon. $40 for consult. I believe the nutritionist is covered by insurance, if not probably $40 for each visit. The surgery is covered 90% by insurance. All the other preoperative tests like the gastroscopy, chest xray, cardiogram and bloodwork are covered by the insurance. As far as I know each preop and postop visit with the surgeon is $40 each appt. The main thing is that our insurance pays for the surgery nowadays. Good luck with your journey...

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[cls5186 23]

I have an appt with my primary doctor Tuesday, I figured I would see a surgeon when I was ready to have the surgery, and the 6 month visits would be to a nutritionist or my doctor. Should I see a surgeon first?

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[marnie86meg 1]

The first thing I did was attend a seminar on bariatric surgery. I told my primary doctor that I went to a seminar and that I have an appt with the surgeon that did the seminar. My primary doc was very supportive and gave me the medical clearance for the surgery. What I would do first is attend a seminar and take it from there. They explain the different surgeries that are offered and lots of questions and answers about WLS in general. Good luck to you.

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[estar7708 0]

Hi! I also have this insurance. Is there anyway around the 6 months? I met with a surgeon....I have cardiology and pulmonary clearance,:did the psych eval and one nutritionist appointment.,really don't want to have to wait 6 months!

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[thisgirlhunts 94]

I have the same insurance. I found the 6 months of NUT visits to be helpful in preparing for the lifestyle changes that this surgery requires.

There is a weight loss requirement for the insurance--I think it was 5% of your body weight. My NUT helped me set goals for losing weight pre-op, held me accountable, and taught me the progression of the diet stages after surgery.

My practice also has exercise physiologist that I met with prior to surgery to design a plan to get me moving.

I would advise you not to rush the process. I feel the more educated you are about your body, the surgery, and the "after", the more prepared you will be for long-term success.

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[Clarevoyant 347]

Many of the tests are required by the surgeon rather than insurance. They want to make sure you can handle it. There are the insurance requirements and the. The additional things required by the surgeon. For me this was the swallow test, cardiologist and pulmonologist.

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[estar7708 0]

My surgeon never said anything about a weight loss requirement. My BMI is borderline (39/40). I've done pulmonary, cardiology, NUT, psych and headed for the sleep study. I'm nursing my 8 month old so I don't mind the fall but I don't feel I need 6 months. My surgeon said 3/4 months which seemed more reasonable. My consult was 6/15.

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[estar7708 0]

I also exercise a lot. I lost 90 lbs through diet pills and maintained 12 years. It was multiple pregnancies that it put back on. Exercise has never been my problem it's food :-(

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[walkermy 86]

Most practices have seminars or support group meetings you can attend. If not set up a consult with your surgeon. You may get answers to a lot of your questions there.

[cls5186 23]

Thanks guys, you've really helped a lot! Best wishes to absolutely everyone I'm thinking you're right about the insurance not necessarily needing you to have all the tests, but the surgeon to require it--makes sense, to be healthy and on the safe side about it.

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