I need some help from anyone that has blue cross blue shield..... as well as other...

HEY YALL,

 

So I just had some quick questions ...that I hope you can answer....

so as most of you know.... looking into doing the surgery is a big step... and actually submitting insurance is a even bigger step... but then getting the approval...is another big step.. and finally going to the surgeons office to schedule it... is the beginning of a whole new life..... so me? I have no made it past the insurance approval just yet...

 

what were your requirements before you could submit it??? I know everyones is a little different.....

how long did you wait to get an approval?

how long did it take you to get scheduled in with your surgeon??

Finally,after meeting with the surgeon.. how long after that did you have to wait to get the surgery date??

 

I know everyones will be different..just curious about everyones experiences,,,,

Thank yall!!

 Hayley

ps....anyone from TEXAS?

 

I think you have the process backwards.  Take a breath.  You do not get approval - your doctor's office does that.  They will be well versed in what a major carrier like BCBS requires.  The surgeon submits all the paperwork, not you. (Thank you Jesus.)  The only thing I remember signing was a certification that I had tried repeatedly to lose weight without success.

 Your first step going to Public Info Meetings put on by the surgeons.

I had BCBS in New Jersey, but the process is prob the same.  Go to a the public meetings of a few doctors and meet with the one you think you jive with the best - you will be with them for years(if all works out well).  Then, when you go to the office, you will get a list of all the things that your insurer requires (pre-surgery diet, psych consult).  There is a person called  a Navigagtor who will help you schedule appointments and will put it all together for approval.  I had no direct contact with BCBS.

I may have had a unique experieince becasue I wanted surgery right before Christmas, when not alot of people wanted major surgery so I got booked quickly.  I got approval on Wednesdy and had surgery on Monday, 5 days later. 

This may not seem like  big thing, but when I met with the doctor, I asked about the pureed food stage.  (I knew I would just gag on it - that was my biggest concern about doing the surgery.)  When he said he does not believe in a pureed food stage, I was so relieved and was ready to do it.  (He has patients on all liquid for 7 days then soft foods foods - yogurt, poached fish, etc, and we chew it well.  So it is probably the same when it hits the stomach, but I never had to puree anything.)

Get started by booking a few public info meetings - you are not committing to anything, but it get ball rolling and if you like the surgeon, you can book an appt with them after the public meeting.

 

 

Contact your insurance via the phone number on the back of the card and customer service will tell you what your requirements are

Go to the seminar that your surgeon may give

They will tell you there how to go about making an appointment

The schedule to get into the surgeon is dependent on his/her practice, only the office will be able to provide the time line for getting an appointment

As far as a surgery date you are going to need to ask the doctor or the staff as they might have pre operative testing to go through, meet with the a therapist or nutritionist, you may have to get paperwork from other doctors like your gyno, PCP, letter of recommendation from the PCP for surgery, provide info on other preexisting conditions like sleep apnea, diabetes control to name a few things

Everyone's health is different so there really isn't a way to tell you a time line. I had a three month practice diet to train me on how to eat, make life style changes and exercise PO, the doctor during that time got my insurance approval and at my next appointment he went over my eating, exercise, water, vitamin journal (that all of his patients needed to provide), I saw his nutritionist and exercise physiologist and bariatric nurse. It was then that I was scheduled for surgery. So from start to finish for me it was close to six months.

Your insurance may require monthly weigh-ins with your PCP for six months to a year - consecutive. A word of info on that is to make sure that you go to each of those weigh-ins and do not skip one.

Hope this gives your some insight into the process.

PS - edited to add that I had BCBS of IL then and still have the same insurance from my former employer. I recently retired and can take the insurance with me due to being a municipal employee. Basically until I go on Medicare in a couple of years. Yippee for me.

Thnk  you soo much!! it was  helpful!!

Hayley

I have BCBS Arizona. Everyone's plan is different, but here's what I went through:

In August, I attended an informational seminar at the surgeon's office.

September was my first visit where we talked about the process and officially got started.

I had to do a three-month medically-supervised diet, so I had checkups with my PCP in September, October, and November.

I spent those three months rounding up other paperwork, including my cardiology clearance, results from the sleep study I'd had done about a year prior, letter of approval from my psychiatrist, and medical records to prove five years' history of morbid obesity.

The surgeon's office sent everything to BCBS in mid-November. It took two weeks to get approval. Once we had that OK, I got my surgery date the following week, and I went under the knife in mid-December.

I'm from TEXAS!! Houston area. I have BCBS of New Jersey and My surgeons office did everything. They even scheduled my surgery before they submitted everything to my insurance for approval. The office called me and said I was approved after 3 days! I had surgery the next week!

I have UHC...but...

It was unclear whether or not I needed the 6 month supervised diet -- I already had it before I went to the surgeon...

100 days from my decision to pursue it to it actually happening.

I have BCBSTX, but everyone's plan is different.  All I did...even before I scheduled my first appt with the surgeon...was call insurance, ask what the requirements were, etc.

I didn't have to do a six-month diet study, or a sleep study, etc.  I'm pretty young, so some of the things that most surgeons require didn't apply to me.   Here's the list of the steps that I had to go through in date order:

9/7/16 - initial surgeon consult

9/17/16 - psych evaluation (did this over the phone)

9/21/16 - EGD

9/23/16 - Informational seminar w/ surgeon

10/5/16 - EGD follow-up, last minute chart prep for insurance

10/17/16 - information sent to BCBSTX for approval (there was a little misunderstanding, so it wasn't submitted right away.)

10/25/16 - Called BCBSTX and found out I had approval; called surgeons office.  They wanted to schedule me for 10/31/16, which was the following Monday.  Not good timing for me. Scheduled for 11/28/16.

11/22/16 - EKG and pre-op bloodwork at local hospital

11/28/16 - RNY

So, I could have had surgery a few days shy of two months from when I had the initial consult, but I chose to postpone until after my boys' birthdays and Thanksgiving, but I was good with it as long as I could get it before the end of the year. 

And I'm a Texan! 

Every office is different.

I selected a new bariatric program in Chicago (Elmhurst Hospital, which I cannot recommend enouh FWIW).  Because it was new and I was one of their very first, the process was fast.  It takes much longer now.  I went from first consult in March to surgery in June.  Of course I already had years of documented weight loss, obesity, and comorbidities.  I had a recent sleep study and other things they also order for insurance approval done which also shortened it.

I also had BCBSIL PPO insurance via work.  Approval was simple.  Waiting for the tests took longer.

Was able to schedule with my surgeon immediately.  Again, it was a very new practice at the time.  Now it is much busier and takes longer.

are you sure it is a covered benefit on your plan? 

I have BCBS and it was excluded on my plan, not covered at all.