Highmark PPO Blue - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

XsMama · 09-03-2009, 06:44 AM

Anyone ever had issues with getting them to approve surgery? I haven't even been submitted yet because I'm still doing the pre-op testing. I was just curious.

sherry7 · 09-06-2009, 09:34 AM

No problem at all...in fact, after everything was submitted, it only took 2 or 3 days until the decision.

The stickler is making sure your surgeon's office (and you) gather all of the appropriate info to be submitted to the insurance company. I went to Magee in Pittsburgh, and they were very thorough with getting the proper stuff done, providing that the person did their 6 month pre-op diet through them, and not their PCP.

anniedolph26 · 09-06-2009, 11:16 AM

My experience was easy. But like Sherry said, everything has to be documented. I had a BMI of 41 plus I have type 2 diabetes and High blood pressure. They approved me within 24 hours. It depends on the thouroghness of your doc.
Good luck.

SLRteach · 09-06-2009, 08:28 PM

I go for my first of six PCP Dr. appt's on Wednesday. I figure if I go Sept-Feb, that will be my six months. I am hoping that my insurance co will accept this.

I have a letter from Dr. Newlin to give my PCP and a form for them to fill out to document the six months of weight loss attempts. I am planning to schedule my nut evel with Dona soon. Is it my responsiblity to keep all the records of the appts to submit to insurance or will Dr. Newlins office do that for me?

sherry7 · 09-06-2009, 08:49 PM

Quote:

Originally Posted by SLRteach

I go for my first of six PCP Dr. appt's on Wednesday. I figure if I go Sept-Feb, that will be my six months. I am hoping that my insurance co will accept this.

I have a letter from Dr. Newlin to give my PCP and a form for them to fill out to document the six months of weight loss attempts. I am planning to schedule my nut evel with Dona soon. Is it my responsiblity to keep all the records of the appts to submit to insurance or will Dr. Newlins office do that for me?

I don't know. I went to Magee (in Pittsburgh) and did my 6 months of pre-op classes through them. In return, they submitted everything for me. If you're doing your pre-op through your PCP, I would imagine that it's totally different. Best thing to do is call your surgeon's office and ask them.

samtherockstar85 · 09-06-2009, 09:00 PM

I have Highmark too but I won't know how smoothly it'll go until early next month when they submit my paperwork. I hear it's very easy to get approved by them.

LoriAnn925 · 09-07-2009, 04:52 AM

I was denied the first time my surgeon submitted my paperwork, but I expected that because I didn't have the 6 month medically supervised diet documented. so even before we submitted the first time I started my 6 month with my pcp. I started my 6 month in January, my surgeon submitted to my insurance for the first time in february, I was denied in March, I had my pcp send my paperwork to my surgeon in June, my surgeon resubmitted in july and I was approved 2 days after my insurance company received the paperwork in august. My surgery was in September.

MommaKatie · 09-22-2009, 09:44 AM

I have Highmark BSBS PPO in Pennsylvania and after my 6 month supervised diet, my surgeons office submitted my paperwork, and I was approved in days!!! No problems at all. I did have a BMI over 50 and type 2 diabetes also, but I think as long as you meet there requirements, they are pretty good with the approvals!

lbailey29 · 09-23-2009, 03:56 PM

Hi! I'm new to the group and I just started my journey for my WLS. Does anyone have UMR (United Health Care) and if so, did you have any problems getting approved.