BCBS "blue hospital cert" ??

Dee1728 · June 2, 2008

Hi. I'm Dee and I am sort of new here. Today was my very first appointment with True Results in Richardson, Texas. I live in McKinney and work in Plano. The good news is my insurance will pay for the lapband, if I prove I can't diet lol. The bad news was BCBS requires I go to a "certified blue hospital" to have the surgery. Now I'm back to not having the money to pay the hospital. Seems like BCBS will only pay 50% of the hospital bill now because of this. Has anyone had this experience?? The only hospital they seem to have found with this "certification" is near Denton, about 45 mins away from McKinney.

And they, BCBS, expect me to try dieting for 6 months before it will totally be approved. Geez...if I could "diet" why would I be trying to get lapband? Dam insurance!~ Corporate yuk! I hate all this.

And will all of this, is my concern of letting go of the excess food after lapband. Huh. I will be on all these boards reading and hoping to connect with others as well.

Thanks in advance.

Newbie, Dee:biggrin2:

tyman311 · June 2, 2008

You can utilize any history you have of dieting. I have BCBS and got approved immediately based on my extensive history of weight watchers, diet pills, weight loss problems and documented history with physicians. Try getting your medical records and showing your history.

TheYear of Me · June 2, 2008

Hi Dee,

I just finished my six months wait with BCBS and I went through True Results and I have to have my surgery in Decatur too!

At first it seemed like the six months was going to take forever but I realized that it gave me time to prepare myself by doing more reading and researching about the lapband. I had to meet with the psych person at True Results and he gave me the name of a book to read and it was helpful too.

I am having surgery one week from today and am excited. I am waiting for the hospital to call me. They called Friday and pre-admitted me and now I'm just waiting to find out the time.

You might want to check to see if the surgeon you chose to use from True Results is approved by BCBS. The one I had chosen was out of my network and I didn't know that until my insurance approval was submitted.

I had a great experience with True Results and I hope you do too!

BandedButterfly · June 2, 2008

Hello. Most insurance companies do want to see that you have attempted weight loss for them to approve it. I did the same thing the other lady did. I got documents from all the gyms I was a member of. Ihad my doctor write a letter explaining all the things we tried to do to help me lose weight...such as lower cal diet, other diets, diet pills, etc. and I actually created my own timeline that advised when I did certain things. Such as purchased exercise equipment, tookt he pills, tried the release program from GNC, etc. And that is all they wanted. I was approved. Some insurances do require you to try for 6 months and have it all documented. If that is the case, that is something you will have to decide if you want to do. Personally I would think of it as: In 6 months I'm either going to be where I am now or getting my band. Good luck to you!

chefsteph · June 3, 2008

Hi Dee,

I also have BCBS and I went though True Results but the insurance would not pay if i had it done at the clinic. They require me to stay over night. So True Results found one of their doctors that was on my network and assigned me to him. And one of the hospitals that was also on my network was one that they use, so it all worked out to my benefit b/c the ins. payed 90% of the doctor, 90% of the anesthesiologist, and 80% of the doctor. I payed pennies compared to other people. I still did my monthly weigh in's and eveything else at the True Results clinic. And don't worry about the 6 months of dieting. I actually gained a little weight. I didn't do a thing. I ate normal, sometimes a little more :lol: , walked a little, and did all the stuff they told me to do, like see the nutrionalist, weight history from family doctor, mental exam, etc.. I thought it was going to take forever, but it was over before i knew it and the ins. only took a week and a half to approve me. I am now 4 days post-op(May 29th) and glad i had the time to prepare. It helped having the time to set my mind to the changes that would happen and how my eating habits would change. Now that it is all done, I don't feel like i rushed into it. It will all work out, just be patient and do what they tell you to do and it will all pay off. Keep us posted.