BMI 39-bcbs of north carolina

[flipp98 0]

Ok, all that have bcbs of north carolina. Approx how long does it take to get an approval from your insurance co. I know that there is a process I have to initially go through with my PD and the surgeon who's gonna do the banding, but I was informed that the longest wait is on the insurance co. Is there anyone with bcbs of nc that know?

Thanks

I have bcbs of north carolina and I work there. It only takes a few a days to get an approval once your doctor sends in the info. Dr. Enochs office sent my paperwork this Monday and I was approved Tuesday. It only takes longer if it's denied and they have to file an appeal. I didn't have to have a 6 month supervised diet, I just submitted my medical records to show my bmi for the last 2 years, had all the tests and evaluations. I have an appt 05/19 to schedule, I'm hoping for a June surgery date!!!

[Cloteal 0]

I have bcbs of north carolina and I work there. It only takes a few a days to get an approval once your doctor sends in the info. Dr. Enochs office sent my paperwork this Monday and I was approved Tuesday. It only takes longer if it's denied and they have to file an appeal. I didn't have to have a 6 month supervised diet, I just submitted my medical records to show my bmi for the last 2 years, had all the tests and evaluations. I have an appt 05/19 to schedule, I'm hoping for a June surgery date!!!

Congrats to you. I hope you get your June surgery date, keep us posted. Yes, I did contact my insurance co which is BCBS of NC, I do meet the requirements as long as my BMI is 40, which it is. I'm going through Duke Medical Weightloss Center, as I heard they were really great (a center of excellence) and they have been good with making sure you have everything thats needed for approval. Being that they are a center of excellence they have many applicants and it will take atleast 4 weeks to even get an appt with the surgeon. But I'll keep you all posted. I know there will be someone like me who will want to know the procedure, how long it takes and what next, so I will be there for them to. Thanks so much for your post, it was really relieving to know that BCBS does not take long for approval.

Edited May 16, 2009 by Cloteal

[skep 9]

since you're going to Duke, just a couple of other bits of information. I just trusted the doctor about the band. I finally asked about it my last appointment. I got the 10CC lapband AP and with a single incision surgery. Once you get the appointment, the process moves really fast. I saw the doctor the first time on 12/22, mainly because someone canceled. I had tests run on 12/29, and was approved on 12/31. I was originally scheduled for surgery on 1/9!!!I actually think I was the one to ask them to slow down! I needed time to process the dietician info. the psych info, the testing, the group meeting, etc. I had the surgery 2/19 at Durham Regional. The surgery is either at Duke or at Durham Regional. I preferred Durham Regional mainly because it is sooo much easier to get into and out of. Duke is a hassle with parking.

[Cloteal 0]

since you're going to Duke, just a couple of other bits of information. I just trusted the doctor about the band. I finally asked about it my last appointment. I got the 10CC lapband AP and with a single incision surgery. Once you get the appointment, the process moves really fast. I saw the doctor the first time on 12/22, mainly because someone canceled. I had tests run on 12/29, and was approved on 12/31. I was originally scheduled for surgery on 1/9!!!I actually think I was the one to ask them to slow down! I needed time to process the dietician info. the psych info, the testing, the group meeting, etc. I had the surgery 2/19 at Durham Regional. The surgery is either at Duke or at Durham Regional. I preferred Durham Regional mainly because it is sooo much easier to get into and out of. Duke is a hassle with parking.

Thank you for that info. If the process goes fast for me I will be ready. I'll keep you posted on my approval etc. Keep up the good work with your weight loss, looks good. Oh, one more thing, did you have to pay for the psych eval up front and what else did you have to pay for up front if any? My insurance co will pay 100% in network, out of network 80%, which Duke Psych Dr's are out of network. So I have to pay $350 upfront for the psych eval.

Edited May 17, 2009 by Cloteal

[skep 9]

Thank you for that info. If the process goes fast for me I will be ready. I'll keep you posted on my approval etc. Keep up the good work with your weight loss, looks good. Oh, one more thing, did you have to pay for the psych eval up front and what else did you have to pay for up front if any? My insurance co will pay 100% in network, out of network 80%, which Duke Psych Dr's are out of network. So I have to pay $350 upfront for the psych eval.

I did have to pay for the psych upfront. They are out of network. That was the only thing I had to pay for since the rest are in network.

[Cloteal 0]

I have bcbs of north carolina and I work there. It only takes a few a days to get an approval once your doctor sends in the info. Dr. Enochs office sent my paperwork this Monday and I was approved Tuesday. It only takes longer if it's denied and they have to file an appeal. I didn't have to have a 6 month supervised diet, I just submitted my medical records to show my bmi for the last 2 years, had all the tests and evaluations. I have an appt 05/19 to schedule, I'm hoping for a June surgery date!!!:cursing:

Can't wait anylonger, did you get your June surgery date?

[Cloteal 0]

I did have to pay for the psych upfront. They are out of network. That was the only thing I had to pay for since the rest are in network.

Hi Skep, it's me again, I was told on yesterday by someone who was going through BCBS of NC that her out of pocket fees were going to be anywhere between $2000-$3000. She wasn't going to Duke it was another Surgeon in NC though. I just want to make sure when I go for my appt, that I'm still waiting for that they don't tell me this. I'm prepared to pay for the psych eval. Just need some assurance. Thanks

[NCLisa 0]

I just got a bill from REX for $7000 for my portion of the surgery. BCBS of NC covers 80%. I was told the entire surgery would be approx $15,000 but the bill was $27,000. I was a little shocked. Can't wait to see the other bills that come in from the other surgical staff that bill seperately.

[Cloteal 0]

I just got a bill from REX for $7000 for my portion of the surgery. BCBS of NC covers 80%. I was told the entire surgery would be approx $15,000 but the bill was $27,000. I was a little shocked. Can't wait to see the other bills that come in from the other surgical staff that bill seperately.

Hi Lisa and thanks for your comment it was very helpful. I called my insurance co and yes, you have to meet the coinsurance deductible, plus your outpatient deductible, and they will pay 80% of total bill if your coinsurance has not been met. After all your deductibles have been met they would then pay 100%. That's the way they explained it to me, I was just concerned that I was going to have to pay up front, but Duke said that they wouldn't know how much I would have to pay until I actually had the surgery and they billed my insurance. Did you have to pay for the psych eval or anything else up front?

[NCLisa 0]

I found an in net work psych in chapel Hill, that was a $50 copay. The nutrionist was free, if you join the BCBS healthy lifestyles program, or something like that, all the nutrionist visits will be free if they are in network and it knocks your prescriptions all down to one tier less expensive.

REX asked I wanted to pay in advance. I said No. I don't have that kind of cash lying around, so I will be making payment arrangements after I get my breakdown from BCBS. I've been screwed over by BCBS so many times before that I want to review each and every claim before I send a payment to anyone.

My daughter fell of her horse about 3 years ago, and broke 3 ribs, a finger, and hit her head (w/helmut on) and instead of paying the claim, they kept sending me letters that she needed to file a workers comp claim before they'd pay as the riding accident was work related. It took about 20 phone calls and the attorney I worked for to write them a letter to get them to pay the bill. Geez, how many 13 year olds have jobs, let alone jobs that involve riding horses?

[Cloteal 0]

Ok, I finally received a call on Friday from Duke to schedule an appt with the surgeon. My first appt is 06/15 with the surgeon, Dr. Sudan, then on 06/30 I see the Psych Dr, I was told I would need $300.00 for this visit (out of network psychs), and when I go again the second visit with the Psych Dr I will need to pay $250.00, which will be reinbursed once I file with my insurance. The Rep that called me said it would be reinbursed, she didn't say at what percentage though, but I spoke with my insurance co BCBS of NC and I believe it will be at 80%.

[skep 9]

Ok, I finally received a call on Friday from Duke to schedule an appt with the surgeon. My first appt is 06/15 with the surgeon, Dr. Sudan, then on 06/30 I see the Psych Dr, I was told I would need $300.00 for this visit (out of network psychs), and when I go again the second visit with the Psych Dr I will need to pay $250.00, which will be reinbursed once I file with my insurance. The Rep that called me said it would be reinbursed, she didn't say at what percentage though, but I spoke with my insurance co BCBS of NC and I believe it will be at 80%.

Congratulations! The day you see the doc they will probably go ahead and schedule your labs. The whole process is incredibly efficient to me, particularly after my first experience. The only bad thing was I once had an appointment with my doc, waited 2 and 1/2 hours to be told he wasn't even there!!!! I see him again on 6/8 as well as the psychologist for my 3 month check up. I'm a bit disappointed that I have lost only 35 pounds, then I remember! I've lost 35 pounds!!!!! That is the most I think I have ever lost on any of my many diets. The difference too is that I just can't eat as much as I used to. So far, the only thing that I have eaten that gets stuck is pork, as in barbecue.

[sterlingstar1 0]

Where are you at in NC? I paid $30 for my Psych. She was in network for BCBS. I actually have the State Employee Health plan throught BCBS. My Nutrionist was not covered, but I found one at Rex Healthcare for $55. The max out of pocket that I will pay is $1000 (my co-insurance limit).

[Cloteal 0]

Where are you at in NC? I paid $30 for my Psych. She was in network for BCBS. I actually have the State Employee Health plan throught BCBS. My Nutrionist was not covered, but I found one at Rex Healthcare for $55. The max out of pocket that I will pay is $1000 (my co-insurance limit).

I live in Fayetteville, but I work in Raleigh. I wonder if I can find my own Psych Dr., or do I have to use one of theirs. Thanks for this information. When were you banded?

[Cloteal 0]

Congratulations! The day you see the doc they will probably go ahead and schedule your labs. The whole process is incredibly efficient to me, particularly after my first experience. The only bad thing was I once had an appointment with my doc, waited 2 and 1/2 hours to be told he wasn't even there!!!! I see him again on 6/8 as well as the psychologist for my 3 month check up. I'm a bit disappointed that I have lost only 35 pounds, then I remember! I've lost 35 pounds!!!!! That is the most I think I have ever lost on any of my many diets. The difference too is that I just can't eat as much as I used to. So far, the only thing that I have eaten that gets stuck is pork, as in barbecue.

Thanks Skep, and I should say congrats to you on your weight loss. You should be proud that you lost 35 pounds , that is a big accomplishment. Keep up the good work.