Bcbs insurance anyone?

[Curiousme 1]

Sorry if this question has come up before, I'm very new. Anyone had the sleeve surgery (I'm in pa) with bcbs insurance? Just curious of your experience with it and the out of pocket? Were they difficult etc? Thank you

[AZBlackhawk 122]

I had bypass but I did have BCBS (of Illinois). It was pretty easy but I wonder if it depends on the plan you are on. I did not need a 3 month medical weight loss. I just had to document what I had tried in the past (weight watchers, Medifast, diet and exercise, etc).

I was only frustrated bc it too a long time to get pre-approval - 3 business weeks! Then they mailed a letter to my surgeons office (snail mail). Once my surgeon received the pre-approval, then bcbs needed to give them pre-certification, which took another 3 business weeks.

***BCBS covered my surgery at 100% (hospital stay only) because I used a Blue Advantage center of excellence. Otherwise I would have paid my coinsurance. I still need to pay the surgeon and doctors, but it saved me a ton of money and I chose an amazing hospital/team to have the surgery.

Call BCBS and talk to someone. They can help you. I called like 3 times before I went for a surgery consult with different questions.

[smb123 51]

I live in North Carolina I have BCBS Anthem (Wells Fargo) of GA. They require a six month diet within the last two years which I have done but without a supervised physician. I actually was just diagnosed with Idiopathic Intracranial Hypertension on Monday which is causing my vision loss so they said they could probably waive it for that reason they just need to documentation from my neurologist.

I had given birth earlier this year so my deductible has already been meet so this surgery will be $0 cost to me. My neurologist said this would be the best option for me since I have PCOS as well and insulin resistance. It's been so hard to lose weight only to keep gaining it back after my body gets used to what I am doing. She said the only thing that will get rid of the PCOS symptoms like insulin resistance and the IIH would be to have drastic weight loss through weight loss surgery.

Looks like they took a long time with you I hope they don't do that to me. My neurologist should be sending them something to day hopefully. My last appointment I would need before surgery is on Sept 6th which is the psych evaluation. I hope they approve everything and get surgery before the end of the year. If I get it next year ill have to pay $4,000 out of pocket.

[OutsideMatchInside 10,166]

I had BCBS of Illinois. I was approved in less than 5 business days. It was a quick and easy process. No supervised diets. I went from first Dr visit to surgery in 8 weeks.

How easy or hard your process is depends on your insurance plan and also the program you select. Some programs make you do 6 months so they can suck as much money out of you as possible, even if your insurance doesn't require it.

[Curiousme 1]

Thank you all! Still waiting for initial call back from the hospital.

[jaejae79 21]

I have anthem bc/bs of VA. I had to visit with my pcp for monthly weight consults/recordings for 6 consecutive months and her approval for surgery, psych eval, nutritionist visit, and cardiac clearance. After completing everything, my surgeons office sent in for approval which took about 2 weeks for anthem to notify me by mail that I was approved. Super excited because it's been a longggg journey.

[Lannie 135]

I also have BCBS of Illinois. I had to do a pre-op nutrition class, meet with the surgeon and have a psych eval. I was approved 10 days after the paperwork was submitted. I have a high deductible plan. After I paid my deductible, BCBS paid 100%.

There are lots of plans under BCBS. When I started me research I contacted the customer service number and they emailed me a list of the "minimum" requirements.

[mytime4me 83]

Sorry if this question has come up before, I'm very new. Anyone had the sleeve surgery (I'm in pa) with bcbs insurance? Just curious of your experience with it and the out of pocket? Were they difficult etc? Thank you

I was just sleeved a few days ago. I have horizon bcbs of NJ. They required the usual 6 month weigh in and safety pre-op stuff but approval was very fast. It took my doctors staff almost a month to compile the paper work to send to them!!! Once they got it, it was fully approved in 48 hours. Know what you need from your coverage, make sure everything is sent over together and hopefully they will approve quickly too!

Good luck

[Jess13 36]

I have BCBS of KC and mine is a 3 month prepping period and $3500 out of pocket (deductible and coinsurance). Everyone's plan is different though. The facility doing your surgery should be able to tell you what it would cost.

[aslack10 7]

I have BCBS of IL and my plan pays 100%. Had a verbal approval within a few hours and maybe 2 weeks for the written approval. Only requirement was that I needed to have surgery at a blue distinction center. Which there isn't one in my state. So surgery will be 2 hours away. No biggie. Gonna get a hotel night before. Have a $1000 deductible and I met that already. I had my consultation on May 4th and have my surgery set for Sept 11th.

[AsianBeauty 78]

I have BCBS-OHIO. I had to do a 6 consecutive month weight management with my PCP. PCP had to fill out medical clearance. Had to get a psych evaluation, blood work EKG and endoscopy, 5 year documented weight ( I got that from my obgyn). My bariatric coordinator submitted my info and I was approved with in 4 hrs. My deductible has already been meet so surgery is paid at 100%. My surgery is scheduled for 9-12.

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[AsianBeauty 78]

Thank you all! Still waiting for initial call back from the hospital.

I would recommend to call your insurance company to check the status. I was very impatient so after about 4 hrs of my info being submitted I called my insurance to check the status of my claim and they told me my claim was approved. My coordinator did not call me for two days. When I spoke with her I just act surprised but I already new lol.

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[danipalm76 5]

I live in Philadelphia. I have personal choice blue cross. They denied my surgery. I'm 3 weeks out to surgery!!! After crying my eyes out I filed an appeal and my doctor is doing the same. Waiting to hear. I'm furious!!!

[AsianBeauty 78]

I live in Philadelphia. I have personal choice blue cross. They denied my surgery. I'm 3 weeks out to surgery!!! After crying my eyes out I filed an appeal and my doctor is doing the same. Waiting to hear. I'm furious!!!

OMG, I am so sorry to hear that. If you don't mind me asking, why did it get denied? I would call your insurance company and ask, " I understand my claim was denied so what do i need to do so that my claim is approved" ask a lot o f question and be persistent about it.

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[fclenz 7]

Wow...I wish you the best of luck and hope you get your appeal approved quickly. I have similar insurance, Independence Administrators, and live outside of Phila. Where will you be getting your surgery done? I am having my done at Bryn Mawr Hospital.