BCBS NC - psychologists and nutritionists?

mpope · May 11, 2008

Does anyone know if BCBS of NC requires the psy. and nurtitionists appts? or is this something the surgeon requires?

suzyt · May 12, 2008

Hi Melissa,

I am in Charlotte and have BCBS of NC. Dr. Gersin will be my surgeon. According to the BCBS of NC policy for gastric surgery, it is one of their requirements although the surgeon would probably want the information even if it was not required. The good news for us is that the insurance person in Dr. Gersin's office said that once all the tests are done and everything is submitted for approval that BCBS of NC is very good about approving within 3 to 5 days, but I have read onhere that for some it only took 1 day!! I think I am a week from submitting my information and I'm getting pretty excited.

Good luck with your journey in Raleigh!

Suzanne

mpope · May 12, 2008

Suzy, have you had all the tests done...the gallbladder, Chest X ray, EKG, etc....

Again, is this a surgeon requirement or a BCBS requirement. Can you get approved before this testing is done or does the surgeon's office wait until you have EVERYTHING turned in i.e. all of these tests, along w/ the nutr. and psy. ????

Foofy · May 12, 2008

BCBS of Mass requires that surgery be performed at a "Center of Excellence." In order to get that rating they need to do psych evaluation (also nutritional counseling). That being said, I don't think there are any guidelines on what is in that evaluation. I kid you not - mine lasted 3 minutes and was done by a young guy who had a BS in psychology. I think there was no way I could have failed that evaluation.

suzyt · May 13, 2008

Melissa,

The day I first met the surgeon, I talked with his physcian's assistant, had blood work drawn and made appointments with their fitness person and the dietician. Since then I have had a sleep study consultation and the actual sleep study, a psych evaluation, gotten two letters of support -- one from my PCP and one from my parents since I am single and live by my self so didn't have a husband to write the support letter, and I had already gotten my five years of documented weight history from my PCP. This Friday, I find out the results of my sleep study and meet with the dietician. And once the doctor's office receives my psych eval -- he said it was ok -- then I am ready to file with Blue Cross.

I am not sure if a chest x-ray, etc is part of the pre-op follow up that is done after you are approved or not. I do still have to attend a support group meeting, but I am going to try to see if they will submit to insurance and delay surgery if I should happen to miss the meeting for some reason -- it would have to be a flood or something for me to miss it at this point!!

How far along in the process are you?

I've actually been staying on everyone and trying to move appointments up whenever possible and Friday will be 30 days from the seminar I attended. As you can tell I am anxious to start life as a bandster!!