BCBS - Carefirst

[cindym44 75]

I decided to opt for bariatric surgery in May 2016 and called to make an appointment with a surgeon. The first available appointment was over a month later, so I took it. The appointment went well and with a BMI of just 35.2, I was told not to lose any weight until I got approved. I did all of the required steps - the appointments with the nutritional dietician, the psycological evaluation and documentation from weight watchers to show my previous attempt at losing weight. I could have easily chosen Medifast or Nutrionsystem, but Weight Watchers was the most recent and the program had to be within the last year.

When I was tryiing to schedule the dietician and psycological evaluation appointments, the first available appointments were not open until July and August. Bummer. I wanted to get this ball rolling as quick as possible, and practically begged for earlier appointments, but was not successful. I had to wait. During this time, I did my own research with my insurance company and found that even though my surgeon was requiring a nutritional appointment, my insurance company did not. I was excited that we actually didn't have to wait for this last appointment and called my surgeon with this good news. My surgeon's assistant promptly informed me that if I opted to have her submit without the nutritional appointment documented, she could not assist me if I got denied. She said I would be on my own. I trusted her and told her we would wait for that documentation after the August appointment. After all, she was the professional and certainly knew more than I did about all this.

My claim was submitted on August 9th and I received approval on August 10th. My surgery date is September 14th. Words of advise...work with a surgeon's office who has experience with claims and let them tell you what documentation is needed, not matter what your insurance company says. I am glad I did.

[justhere4theshow 462]

I had the exact same type of experience. My insurance was pre-authorized and told me AND the bariatric clinic that I had to have six months of pre-op appointments along with all of the other standard hoops to jump through in the meantime (nutrition classes, psych eval, upper endoscopy, classes about how to exercise properly, bloodwork, etc) At my third appointment with the bariatric nurse practitioner, I had completed everything. She told me that she thought BCBS was wrong about requiring me to have three more months of weigh-ins, and she made a phone call. I didn't even get excited about it, because I figured I would have to wait three more months after all, and I didn't want to get my hopes up. It was the end of the day, so I didn't wait around to hear if she got anywhere with BCBS; she said she would let me know. Two days later, an insurance rep at the hospital calls me and says "we need to collect your facility fee of $275 for your upcoming surgery". I said that's fine (still thinking it would be three months later)...But, when the rep gave me the confirmation of the payment, she then said "I'll contact your surgeon and let them know you're ready to go!" I asked exactly what that meant; "Ready to go when?"...and she said the magic words: "Your surgeon can schedule an OR for you as soon as you can do your pre-op diet." Still confused, I asked if she was talking about September/October...nope! I was in the OR two WEEKS later. Turns out my policy requires six months for bypass, but only three months for sleeve. So, it pays to have someone from your surgeon/program to help you with insurance requirements. If she hadn't double checked, I wouldn't even have had my surgery yet. So even though my recovery has been a comedy of errors (on my part), and I am losing slowly, I am glad she made that call to BCBS to get me ahead three months!