BCBS RI requirements?

[ItsMyTime1985 12]

Hi all,

I am just beginning my exploration into bariatric surgery, and am trying to figure out the insurance logistics of it all. The BCBS RI website isn't very helpful besides to say the surgery is covered after my deductible. Does anyone know if they have the 6 month nutrition requirement? I have seen people from other states say the requirement has been removed from their BCBS, but nothing for RI. Also, what about all the preliminary tests and appointments? Are copays due for all those visits? I plan to go through Miriam hospital if I decide to do it. My initial consultation isn't until November and I am trying to research as much as I can before then.

[Yank91 3]

You can call your insurance company and they can direct you. I have BCBS Highmark, I called my insurance and they sent me a Copy of the requirements, it didn't say anything about six months requirement. I have payed co-pay for almost all my pre surgery visits with Nut, surgeon, cardiologist, psych and physical therapy. I started my journey late august, I have my psych appointment on Tuesday after which my surgeon will submit documents for approval from BCBS.

[Subaru 66]

I have BCBS PPO. When I've called they've said that my only requirement is the doctor to send over the pre-authorization request. I've called twice and spoken with 2 different people. I suspect that they have requirements for the drs office to include specific information and I'm being sent for a psych eval and to the NUT. The surgeon's office said they've never dealt with an insurance company that doesn't have any requirements. (I'm also going through the Miriam program.) As near as I can tell there is no 6 month nut requirement though.

The Miriam program does require attendance at two pre-op support group meetings (minimum). I'm guessing they also require the psych and the NUT because I'm scheduled for those. And then they do additional testing after they get approval. (In my case I will not need a sleep study because I sent them results of one from last year. No endo because they have results from one and seem to prefer upper GI/barium swallow test.)

Not all of Miriam's surgeons do things exactly the same way though. Dr. Ryder requires you to attend an in person orientation where all the other surgeons accept the online orientation.

[BeTrue83 44]

I have BCBS PPO. When I've called they've said that my only requirement is the doctor to send over the pre-authorization request. I've called twice and spoken with 2 different people. I suspect that they have requirements for the drs office to include specific information and I'm being sent for a psych eval and to the NUT. The surgeon's office said they've never dealt with an insurance company that doesn't have any requirements. (I'm also going through the Miriam program.) As near as I can tell there is no 6 month nut requirement though.
The Miriam program does require attendance at two pre-op support group meetings (minimum). I'm guessing they also require the psych and the NUT because I'm scheduled for those. And then they do additional testing after they get approval. (In my case I will not need a sleep study because I sent them results of one from last year. No endo because they have results from one and seem to prefer upper GI/barium swallow test.)
Not all of Miriam's surgeons do things exactly the same way though. Dr. Ryder requires you to attend an in person orientation where all the other surgeons accept the online orientation.

Hey hun I am in the same exact boat on have BCBS of NC and it's also a PPO. I was told they recently changed the stipulations for the better on our end which means you no longer have to do 12 months. I had my initial consult 9/28 was given a pre cert form for my medical doctor to fill out and a list of labs and test. I was also given my appointment for the NUT and my psych eval. I go back to the surgeons office Thursday. My appointment to see the psych is in November and I also go back to the NUT in November.

[Subaru 66]

On 10/14/2017 at 8:50 AM, BeTrue83 said:

Hey hun I am in the same exact boat on have BCBS of NC and it's also a PPO. I was told they recently changed the stipulations for the better on our end which means you no longer have to do 12 months. I had my initial consult 9/28 was given a pre cert form for my medical doctor to fill out and a list of labs and test. I was also given my appointment for the NUT and my psych eval. I go back to the surgeons office Thursday. My appointment to see the psych is in November and I also go back to the NUT in November.

Have they given you any sense of other requirements or how long you'll have to visit the NUT? I was able to complete my psych eval in two back-to-back sessions (allowed by this insurance plan but not all I gather). I also had some homework that I dropped off the next day. The Dr. is writing my report and I'll meet with him in 2 weeks to review but then I'm done with him. At the time of my in-person visit he didn't see anything to that point to stop me from being approved. My NUT visit is in two weeks. My surgeon said after they have both signed off they submit to my insurance and then after that approval it's about a month to surgery date, with other assorted tests in between.

I'm hoping for a January-ish surgery date. The surgeon told me it's usually a 6 month process but given how motivated I seemed to be (based on all the documentation I already had sent to him prior to my appointment) he thought January was a reasonable goal.

[BeTrue83 44]

Have they given you any sense of other requirements or how long you'll have to visit the NUT? I was able to complete my psych eval in two back-to-back sessions (allowed by this insurance plan but not all I gather). I also had some homework that I dropped off the next day. The Dr. is writing my report and I'll meet with him in 2 weeks to review but then I'm done with him. At the time of my in-person visit he didn't see anything to that point to stop me from being approved. My NUT visit is in two weeks. My surgeon said after they have both signed off they submit to my insurance and then after that approval it's about a month to surgery date, with other assorted tests in between.
I'm hoping for a January-ish surgery date. The surgeon told me it's usually a 6 month process but given how motivated I seemed to be (based on all the documentation I already had sent to him prior to my appointment) he thought January was a reasonable goal.

That is awesome!!! It sounds like you are on top of things. I am hoping for January date but I am not sure I will have more info for you on Thursday.. Any other questions you would like me to ask when I go Thursday just let me know

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[Subaru 66]

5 minutes ago, BeTrue83 said:

That is awesome!!! It sounds like you are on top of things. I am hoping for January date but I am not sure I will have more info for you on Thursday.. Any other questions you would like me to ask when I go Thursday just let me know

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Nothing in particular, but I'll be interested to hear how it goes. Best of luck!

[BeTrue83 44]

Nothing in particular, but I'll be interested to hear how it goes. Best of luck!

I definitely will update you and thank you!! We got this!!!

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[ItsMyTime1985 12]

2 hours ago, Subaru said:

Have they given you any sense of other requirements or how long you'll have to visit the NUT? I was able to complete my psych eval in two back-to-back sessions (allowed by this insurance plan but not all I gather). I also had some homework that I dropped off the next day. The Dr. is writing my report and I'll meet with him in 2 weeks to review but then I'm done with him. At the time of my in-person visit he didn't see anything to that point to stop me from being approved. My NUT visit is in two weeks. My surgeon said after they have both signed off they submit to my insurance and then after that approval it's about a month to surgery date, with other assorted tests in between.

I'm hoping for a January-ish surgery date. The surgeon told me it's usually a 6 month process but given how motivated I seemed to be (based on all the documentation I already had sent to him prior to my appointment) he thought January was a reasonable goal.

I see you're in RI, what hospital/surgeon are you using? I am still struggling to decide if surgery is the right option for me. It's a scary step, and I wish I could do it without surgery...but I am afraid I can not.

[Subaru 66]

1 hour ago, ItsMyTime1985 said:

I see you're in RI, what hospital/surgeon are you using? I am still struggling to decide if surgery is the right option for me. It's a scary step, and I wish I could do it without surgery...but I am afraid I can not.

I'm going through The Miriam Hospital's Bariatric program. My surgeon will be Dr. Todd Stafford. I didn't choose him. When you do the online orientation and request a consult they schedule you with someone. He seems very nice! As near as I can tell, the program and Miriam and at Roger Williams are both pretty good but I have an old hatred for Roger Williams. The Miriam has monthly support groups for pre-op patients (that go toward the required visits) so you might want to check that out. It's a touch decision for sure. Good luck!

[ItsMyTime1985 12]

4 minutes ago, Subaru said:

I'm going through The Miriam Hospital's Bariatric program. My surgeon will be Dr. Todd Stafford. I didn't choose him. When you do the online orientation and request a consult they schedule you with someone. He seems very nice! As near as I can tell, the program and Miriam and at Roger Williams are both pretty good but I have an old hatred for Roger Williams. The Miriam has monthly support groups for pre-op patients (that go toward the required visits) so you might want to check that out. It's a touch decision for sure. Good luck!

Yea, I have started with Miriam as well. I got assigned to Dr Siva Vithiananthan (glad I could find that name to copy and paste. I'm not even sure how to pronounce it! haha), my first appointment is November 16. I did go to the support group in September as I knew it was a requirement and I thought it might help me make a decision, but it didn't. They mostly just talked about moving more and eating healthy and wasn't much different then what I've heard at countless Weight Watchers meetings. I was kind of disappointed the surgery itself wasn't discussed much. Good luck to you too!

[Subaru 66]

1 hour ago, ItsMyTime1985 said:

Yea, I have started with Miriam as well. I got assigned to Dr Siva Vithiananthan (glad I could find that name to copy and paste. I'm not even sure how to pronounce it! haha), my first appointment is November 16. I did go to the support group in September as I knew it was a requirement and I thought it might help me make a decision, but it didn't. They mostly just talked about moving more and eating healthy and wasn't much different then what I've heard at countless Weight Watchers meetings. I was kind of disappointed the surgery itself wasn't discussed much. Good luck to you too!

I've just done tons of research and made the decision before I ever went to one of the groups. (I was at the September group as well.) There are also a couple of good Facebook groups where you can get decent feedback. A bit of drama in them, but overall I've found them to be helpful in solidifying my decision.

Dr. V. is supposed to be very good. I have a friend going to him for a revision.

I'm also trying to find out how much extra $ it would cost to have a private room at the Miriam. My ex had a private room after a kidney surgery, and that was the standard on that floor for the kinds of surgeries that folks have. I think the bariatric surgeries tend to all recover on the same floor in double rooms. But I don't want to deal with someone else's whining in the midst of my own so if it's something I can afford to do I'm looking at it.

[ItsMyTime1985 12]

17 minutes ago, Subaru said:

I've just done tons of research and made the decision before I ever went to one of the groups. (I was at the September group as well.) There are also a couple of good Facebook groups where you can get decent feedback. A bit of drama in them, but overall I've found them to be helpful in solidifying my decision.

Dr. V. is supposed to be very good. I have a friend going to him for a revision.

I'm also trying to find out how much extra $ it would cost to have a private room at the Miriam. My ex had a private room after a kidney surgery, and that was the standard on that floor for the kinds of surgeries that folks have. I think the bariatric surgeries tend to all recover on the same floor in double rooms. But I don't want to deal with someone else's whining in the midst of my own so if it's something I can afford to do I'm looking at it.

I'll look into some fb groups, can you recommend any? My journey started with my PCP suggesting it to me, and it hit me like a ton of bricks. But I figured I should explore it and make the most informed decision possible.

Let me know what you find out about the private room. I've never had any type of surgery so this is all new to me.

[Subaru 66]

16 hours ago, ItsMyTime1985 said:

I'll look into some fb groups, can you recommend any? My journey started with my PCP suggesting it to me, and it hit me like a ton of bricks. But I figured I should explore it and make the most informed decision possible.

Let me know what you find out about the private room. I've never had any type of surgery so this is all new to me.

The two that I most follow are "Gastric bypass support Group" and "Gastric Sleeve Support Group." I find they can be good places to help you think through your decision, get motivation, and be part of your overall research. That said, remember that everyone's experience is different. Some people do post their horror stories. Only you can decide what is best for you.

Here is what led me to the decision to go with bariatric surgery: I've struggled with my weight on and off my whole life. I have had successful weight loss attempts before. However, I am now 52 and have high blood pressure, sleep apnea, severe (though well medicated) GERD, and high cholesterol. I need another tool to aid me in this journey and I can't wait any longer for me to "get motivated." This will help force me into motivation and, hopefully, be a tool to help me stay on track.

[BeTrue83 44]

Nothing in particular, but I'll be interested to hear how it goes. Best of luck!

Good afternoon the appointment went well I meet with the surgeon December 11 for my date .

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