BCBS requirements

[Racshelle 17]

Hello all,

I have a few questions. My insurance is changing to BCBSFED, with my husband working at the hospital on base. Where do I start the process and who should I contact first? I feel a little lost with the information. Help please.

Hello all,

I have a few questions. My insurance is changing to BCBSFED, with my husband working at the hospital on base. Where do I start the process and who should I contact first? I feel a little lost with the information. Help please.

first see your primary care physician, most all insurance companies require a letter from your PCP to write a letter of medical necessity and medical clearance referring you to a bariatric surgeon. It will be a good idea to write your own and take it to the PCP as most do not know how to write the letter. Search sample letters of medical necessity for bariatric surgery emory healthcare. It should provide you a search result from emory healthcare that offers sample letters of medical necessity that you can tailor to your needs. I did and was approved on my first submission and had my RNY surgery on October 26, 2016. Hope this helps I will be glad to offer you any other information that I can.

Also, search on this board BCBS requirements and see what others have said your insurance required for them, there can be some differences based on how your policy is set up versus someone else who has the same insurance. This can also help inform you. Once you see the bariatric surgeon of your choice they will tell you the requirements of your insurance to be approved. Sometime the insurance companies may tell you, sometimes they won't telling you that you must get that information from the bariatric surgeon.

[gigiinDC 70]

I have BCBS FED Basic Ppo. I had 90 days supervised diet with a nutritionist a psych evaluation (over the phone interview), and another physical. If you are at 40 BMI it is easier.. no comobidity required. If you are under 40 bmi they require at least two comorbilities. My primary physician referred me to the Bariatric surgeon but only for nutrition services as my bmi was under 40 at the time of the referral and he told me I would not be approved for surgery. Once I saw the surgeon she told me I could qualify even though I wasn't at 40bmi.. it was a bit confusing but long story short I was approved.

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Edited November 14, 2016 by gigiinDC

[iamworthy 7]

you have a right to know what your insurance covers, i would be talking to the manager and demand answers...

I tried calling them three times and they won't release any info on that topic with me. They tell me to call the surgeons office. They also won't say anything until my appt. So I gave up and will just wait. But I did start mtg with my PCP monthly anyways can't hurt anything.


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[blessedbeyondmeasure2 0]

I am a teacher and have BCBS state of Mississippi. My weight management doctor keeps telling me she can get me approved. I am just a little skeptical. I have just been diagnosed with sleep apnea. My bmi is 38.2 . Anyone familiar with BCBS of MS?

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[kell911 62]

I have BCBS FED Basic Ppo. I had 90 days supervised diet with a nutritionist a psych evaluation (over the phone interview), and another physical. If you are at 40 BMI it is easier.. no comobidity required. If you are under 40 bmi they require at least two comorbilities. My primary physician referred me to the Bariatric surgeon but only for nutrition services as my bmi was under 40 at the time of the referral and he told me I would not be approved for surgery. Once I saw the surgeon she told me I could qualify even though I wasn't at 40bmi.. it was a bit confusing but long story short I was approved.

Thank you! We also have BCBC FED Basic PPO. I am 36.9 bmi with high cholesterol, type 2 diabetic and possibly sleep apnea. With the referal by your primary for nutrition services, is there anything that I need to make sure that my PCP does for my referal.

Thank you again.

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[Riley0913 0]

I'm in Nebraska and I am doing 3 months monitoring.

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[gigiinDC 70]

No I don't think so just make sure they write that they're diagnosis is obesity and more your comorbidities

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[gigiinDC 70]

You may have to do a sleep study too based on the possible apnea

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