Question:
I am considering the surgery and want to know if anyone knows what BCBS requirements
— mjwest (posted on September 2, 2010)
September 2, 2010
Hi,
I had the RNY 4.5 yrs ago and had BCBS, from what I can remember maybe most
insurance co. are like this but:
You need to have co-morbidities (life threatening issues, like sleep apnea
(stop breathing), acid reflux (can cause cancer in the esphagus), diabetes,
high blood pressure, high cholestrol etc. not all of them but at least one)
a family history of these isn't what they care about. It is what you have
now. Or if you don't have these, then if you are 100 lbs overweight, you
qualify even if you don't have co-morbidities. They require a Pysch
evaluation, and a supervised diet of 6 months. (With that I used my Weight
Watchers records I had kept from years before, and they accepted that)
Jenny Craig, anything that is supervised by either a doctor or a weight
center. I may have left out a few things but that is the main requirements
necessary to qualify for surgery. Hope this helps and I am sure other will
add some details I forgot about. Best wishes.
— Kristy
September 2, 2010
I have Horizon HMO and when I called them they told me they didn't have any
requirements, but that the surgeon probably did. They don't require a 6
month dr. supervised diet any longer. Best thing to do is call them
directly and find out specifics on your policy.
— wannablite
September 2, 2010
Well I have Empire Prism EPO and I wanted the sleeve which was denied and
the appeal did not come through for my surgery date of 8/30/2010. BCBS
appeals nurse called me and said that I qualify for immediate approval for
gastric bypass and lapband but would have to go through numerous appeals
for sleeve. I have chosen the Gastric bypass and am scheduled for 9/13/10.
I was not required to be on any 6mth diet just 3 yrs of documented
weight.(which you get from your family doctor.) I did have quite a few out
of pocket expenses but each individual health coverage is different. Also
if its through your employer you have to make sure it isnt an exclusion. I
wish you all the luck!!!!
— mperez77
September 2, 2010
I had RNY about 6 months ago and have BCBS of NC. I didn't have to get
pre-approval or anything. I just had to go to a Center of Excellence,
which happens to be in my home town. I did have a co-morbidity of high
blood pressure (barely) and a BMI that categorized me as morbidly obese.
I had NO issues with BCBS covering my surgery. I was approved immediately.
Good luck to you!
— spitfire0379
September 2, 2010
I had RNY a month in a half ago and have BCBS Federal. Had the BMI with no
co-morbidities. Was approved immediately without prior authorization. I
had to meet the requirements of my doctor's office before surgery but BCBS
required nothing else of me. I wish you the best of luck!
— HuneeB
September 2, 2010
Monique, I really think you have to call BCBS. From what I read. We all
could have BCBS and all have different requirements or surgery may not be
offered at all. My surgical center tells everyone call your ins.
— That_816_Princess
September 2, 2010
I have BCBS of Illinois. They require a 3 month diet program. My employer
requires a 6 month diet program, so that is what I had to do. They also
wanted a 5 year history. Calling them and asking is probably the best
thing you could do to find out how it works in your state.
— Sara20
September 2, 2010
I have BCBS, they were fairly simple, Six month class, over 100 lbs
overweight, additional condition like high blood pressure, diabetes, etc...
— mrsbrucewayne
September 3, 2010
Yes, you will need to call your Ins. co., I was told each BCBS policy is
designed specifically based upon your EMPLOYERS specifications. I have
BCBS of Alabama, (even though I work in Texas), my employer does allow, but
with 6mos Dr. records, mental eval., you must be 75 lbs over, or have at
least 1 co-morb. illness. Please call your Ins. office and talk directly,
or your Dr. Ins. people should do it for you actually! Good luck in your
search for answers, just keep plugging at it till you get what your looking
for cuz it's so worth it to be healthy and free from the excess
weight....Today is my 1 yr. Anniversary...I've lost 90 lbs, and still
loosing...yippy for me!!
— Lisa1212
September 3, 2010
I have BCBS Federal and I only have the BMI with no co-morbitities. They
approved within 2 months from my appt. with Nutritionist and psych
evaluation. I did not need anything further. My surgery is scheduled for
Nov. 15, 2010.
— [Deactivated Member]
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