Questions for bcbs patients...and other questions

[sheshegirl72 0]

Hello I'm new here. I'm going to my very 1st consult on 5/5 and I'm really excited to learn more about the lap band and am praying I qualify. My bmi is 41.2 or something like that. I have bcbs ppo and they said they cover the procedure if it's outpatient but not inpatient. Has anyone had the procedure done as outpatient? That clinic I'm going through is Barix Clinic (in MI). The lady there said they do outpt and inpt and it depends on insurances and obviously if you need to stay overnight. One thing bcbs said was that I would have to do a 6 mos structured diet. The dr's office said that they just had a meeting about bcbs and from what they were told it just changed and I just need to fill out a diet history form and their dr's can sign off on it. I am just wondering if anyone else has heard this? I called my insurance company about a week ago and they said I had to do the 6 mos strict diet first, but then this week I called to set up the consultation and thats when the lady told me it just changed. I have had problems with bcbs in the past telling me different things so I am hoping I dont have to do the 6 mos diet before hand.

Anyways, just curious what all the whole process entails? The clinic said from date of consult until day of surgery is usually from 30-90 days out. I won't need a sleep test probably because I already have sleep apnea, but I was wondering about the psych evaluation and what else you usually have to do ahead of time? Any help is deeply appreciated.

Thanks,

Sheshegirl72

[poppet 0]

Hi there-

While I'm not an insurance expert, I have Empire Blue Cross Blue Shield, and all they have required is the documentation (basically your statement signed by the doc) to determine medical necessity. I haven't been approved yet, but this is how I understand it to be. There was some confusion with the doctor's office, but BCBS indicated that it wasn't a problem. Good luck!

[sheshegirl72 0]

Thanks Poppet for your help. That's basically what the lady at the Barix clinic said that bcbs is requiring now. I have a list i need to fill out of diets I've tried over the last few years and how much I lost, etc and then she said the dr at the clinic can sign off on it from what she was told in a meeting last week. She said it was a recent change. I need to call my ins again to find out if they can maybe send me a list of requirements because I tried writing them down but couldn't remember them all and forgot to verify if they pay at 100%. I have good ins and they usually do but we will see.

[raelita 0]

Hi I am new to this site and to blogging. I have BCBS of TX. I went through the six months structured diet. I had to meet with a nutritionist and a baratrician <-- which is basically an internal medicine dr. that specializes in treating lapbanders. I also had to join a gym and participate in two support group sessions. My procedure was approved, but it took BCBS 3 months to approve it. Once it was approved they did not notify me or my dr. office. My dr. office call for 3 months (from Dec. to March) and they were given the run around. I called in March and was told immediately that the procedure was approved. Now we're having issues with the pre-auth, and I am scheduled to have surgery in 3 days. I can go on and on with my issues, but I will not bore you. In a nut shell the 6 mos. structured diet was way easier than my current waiting game. This is seriously taking a mental and physical told on me. I really hope your process will be much easier than mine.

[sheshegirl72 0]

Wow that sucks that they didn't call your dr to let you know you were approved. I am going to my group consult on Tuesday, then will talk to the surgeon so we will see what they say. I really hope I don't have to do a 6 mos diet.

[REALIZEinCT 0]

I was banded on 4/1/09. I have Anthem BCBS (in CT). My BMI was 41.5 and the only co-morbidity I had is GERD. My PC had to submit a letter to the surgeon (which was forwarded to ins. co) stating that he agrees with the surgery and giving a historical weight and any attempts to lose weight. The psychologist did the same. Other than that it was smooth sailing; easy approval. Good Luck!

[sheshegirl72 0]

Wow I see you've lost 38lbs already. Thats awesome! So how long did the process take from your consult til your surgery? I was just curious. I have acid reflux but don't they do an upper GI or something to make sure you are ok? I have wondered if it was an ulcer but was never tested with the scope down my throat and I take prilosec daily by rx (40mg) and I don't have any issues now, so my dr kinda chalked it up to acid reflux.

[WendyII 0]

My band is from Barix and I have Empire Blue. You should have no problems. Barix is GREAT. My band was done as outpatient. Who is your surgeon?

[TSB 1]

I have Anthem BCBS of Maine. Even with same insurance company, requirements can vary depending on the specific policy that you have.

[sheshegirl72 0]

Did either of you need to do a 6 mos diet prior? Barix said that it should only take 30-90 days but I need to call my ins again. Everytime I call for things i get a different answer outta bcbs of MI.

I haven't met the surgeon yet but they scheduled my consult with a Dr Jamokay Taylor. The email I got was from his office saying "Warrenton Weight Loss onf site at Barix Clinics. Sorry my text changed when I copied his name in here. lol

[WendyII 0]

Check out the Barix message boards. I seem to remember them saying something about a recent change with BC/BS of Michigan NOT requiring a 6 month diet. Dr. Nunn told me that if I got everythign to them it might only take about 6 weeks and he was right.

Here I found the link to the thread at Barix http://barixclinicsstore.websitetoolbox.com/post?id=3449153

Edited May 1, 2009 by WendyII

[REALIZEinCT 0]

Thanks for the compliment sheshe! The process for me was very easy. I had the normal surgeon consult, psych, nutriotionalist and the usual blood tests, and abdominal ultrasound. I was on Prevacid (30mg) everyday but have not needed it since surgery! Because of my age and otherwise good health, my surgeon did not require any other tests like an endoscopy. He told me that when he does the surgery he checks for hiatal hernia (I didn't have one) anyway so he didn't feel it necessary to put me through anything additional. I went from seminar to surgery in 6 months but could have been there in 4, it was just more convenient for me to have the surgery when I did. Let me know if you have any other questions. Good luck!

[JazzyMom17 2]

I have Anthem BCBS COVA CARE thru the state of VA. That is EXACTLY what my insurance coordinator did for me. Took a detailed list of all the diets that I have tried and all the co-morbidities that I have and the dr. will sign off on the letter and she has already submitted it for approval. I am kinda panicked, b/c I fully expected to have to do everything everyone else on here has had to do. Six-month supervised diet...etc...etc. NOTICE I am STILL WAITING TO HEAR ANYTHING and going insane!!!

[sheshegirl72 0]

I checked with my insurance and they said that it did recently change and the dr just needs to sign off on the form now and they don't require a 6 mos diet. WOW, it JUST changed they said! I am nervous about my consult. Why do some people have upper GI, some have sleep test etc? I have mild sleep apnea so I am wondering if I will have to do a sleep test again.

Have any of you had any problems with eating foods? I am curious about what you can't eat anymore. I'm sure they will go over that with me but I'm just getting ahead of myself to know what to expect :thumbdown:

[beaglemom 0]

It not only depends on the insurance company but the plan itself.

I'm on TRS Active Care through BCBS of Texas and I had to go through 6 months of medically supervised weight loss, 5 year weight history from my doctors and a pysch evaluation. I finished everything on May 1st, and my case manager will submit next week.

I have sleep apnea, diabetes, gastric reflux, arthritis and BMI over 50.

I now wait for 6-9 weeks according to the insurance case manager.

It's frustrating but I am getting there. Just jump through the hoops and you'll be fine.