Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Newbie with lots of insurance related questions!



Recommended Posts

Hi everyone! I am in the beginning stages of the process towards the gastric sleeve surgery, and my seminar is on Thursday. I live in FL, but have BCBS NC through my husband's work. I just got off the phone with their customer service and am very confused, so I am hoping you all can help me!

I have been doing reading online about their requirements for coverage, and I know that BCBS NC just changed their policy to reflect " documentation of 12 consecutive months of active engagement in weight related treatment, as described above. Judgement regarding the scope, depth, and adequacy of pre-surgical treatment during the 12 months prior to surgery is at the discretion of the multidisciplinary weight loss surgery team, and BCBSNC does not specify the content of the treatment."

The lady that I spoke to on the phone said the only requirement was this documentation of 12 months, and when I asked her about the psychological evaluation or the meeting with the nutritionist, she said that those are not showing as required. However, when I check their website, this document states that they ARE required. https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/surgery_for_morbid_obesity.pdf

Now here are my questions:

I have been seeing my PCP off and on since 2013 (did not go when I with between jobs and did not have insurance). I went back to her in June or July of 2016, and have bee going consistently since then. She has documents of my weight from 2013 on, has been working with my on my weight since then, and put in the referral for me to my bariatric surgeon. She is 100% in support of me having the surgery done as soon as possible. I told the rep from BCBS that I don't see my PCP every month, but she didn't know if that would be a problem or not. Thoughts?

Is the approval process for BCBS NC difficult? And how long does it typically take?

And last question: Is the surgical center helpful in this process? This insurance stuff is super overwhelming!!

Thanks so much!

Lisa

Share this post


Link to post
Share on other sites

I can answer the last question, the Bariatric program is usually very helpful as this is all they do! They check exactly what needs to be done and they'll tell you. It's a win win for everyone involved so they are good about checking on it.

Share this post


Link to post
Share on other sites

Also ask for help with insurance from your surgeon's staff. They are the ones that deal with the billing and such and know what I'd required with the different insurance companies.

Share this post


Link to post
Share on other sites

I'd trust what you see on the website over what someone told you. It'd be RARE for them not to require the psych eval. If it says consecutive months, it means consecutive months. You may want to consider doing your consecutive months with your surgeon. That's what I'm doing, and it's going to give me that much more time to get comfortable with him, and for him to get to know me and my habits. I have United Health personally, so can't speak for BCBS approval process, but if you work with your surgeon, he should be able to help with everything!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×