multiple stories about how to get surgery!

[froggin4colorado 0]

I called fed BCBS Monday and talked to a rep about surgery. I specifically asked her if I needed to prove that I had followed my docs weight loss plan for 6 months and I was told that fed BCBS doesn't need to do that anymore. So, I called Penrose and set up an educational consult. Today I was called by Penrose and was told she had recieved a memo that said I needed to follow a 6 month plan. So, I called my doc, set up an appt and they proceded to tell me I didn't need to. So I turned around and called the insurance company again and they again told me I didn't need to. So I called Penrose again and left a message...talk about confusing!

I went ahead and kept my doc appt for my 6 month plan...but talk about getting the run around. Anybody else experience this with fed blue cross blue shield?

[Bobbie155 0]

I have Highmark BCBS and I had to have the 6 months.

[YngGram 73]

I don't have BCBS, however I got the same crazy runaround with the first two surgerons I talked with. After persistance with the "online chat" for my insurance company that led to me speaking with someone from the department that writes policy I discoverd the following:

The six month structrued weight loss program both were stating that was required by the insurance company was not. It was something the surgeon wanted me to do through them at about $350 out of pocket. When I told them I had spoken with the insurance company they tried to convience me that I was not talking to the same people they did. I had to forward the emails I had received and really stand my ground. I told them they lied to me and I didn't like it. One of them then said they would proceed without it if I would sign off on it. I am now working with someone else and the requirement never came up. Also this surgeon does not charge a program fee or for the nutrition classes that I must have.

[bklyn1984 0]

I had this happen to me. The surgery scheduler insisted that I have all of this information because of insurance reason which was not true. These doctor's offices hear BCBS and their thoughts go directly to what they know about BCBS outside of the BCBS Federal plans.

My last visit prior to her sending my information to the insurance I talked with her again and said I was not sure why if BCBS Feds tell me it's not necessary why did they tell her different. She then went onto tell me I do not know I never really worked with this insurance plan. Meaning she never called them her information was based on her experiences with the other BCBS plans.

[Luu2008 2]

I was banded several months ago BCBS. If you go to their website there is a way to find out for sure what their qualifications are. I did not have a 6 month diet. I think you must click through the site as if you are a physician, don't worry I was told to do it by a BCBS rep.

[froggin4colorado 0]

According to the gal I talked to for the surgeon, they just found this out this week when they sent in a claim for payment. Supposedly fed BCBS had sent them a memo Jan 1 that said they were to follow the same 6 month plan like they do with Anthem and that the claim they were sending was going to be denied payment. I am seeking other surgeons to see if I get the same answer but can't find anyone else here in the Springs that fed BCBS has under their preferred providers. I might have to start searching Denver. I did email Dr. K that everyone talks about but they don't work with insurance companies, everyone who goes through him self-pays. In the meantime, I have my appt with my PCP and I am going back on phentermine...yuck. I don't like the side effects of phentermine...I am a zombie on it. I only sleep 3 hours a night on it and I am not really coherent on it.

[iwalktheline 1]

keep going to the doc every month on time and have you weighed and documented until you are holding the officical authorization from insurance. I had this happen to me w/BCBS. the insurance doesn't require it but the MED Group or directors of HR who oversee the insurance policy do. you don't want to be denied in 4 months because you didn't do the diet. just pretend like you have to until you have a sx date set and good luck. i am just waiting to start the liquid preop diet.