(Hi!) Newbie with BCBS MI - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Sparkles · 02-11-2009, 02:30 PM

Hi Everyone,
I am Nichol and I am ready to start my WLS journey! This website has already helped quite a bit. But of course like all newbies I have questions. I received my insurance criteria sheet with the following that needs to be done: But seriously is this it and then “magically” I am approved? So what's the catch?

The Patient has a body mass index greater than 40 or greater than 35 with comorbid conditions. (Check)

The patient is between 18-60 years old. (Check)

A physician has documented failed medical management including a structured professionally or physician-supervised weight-loss program for a minimum of 6 consecutive months within the last 4 years. (My First Dr.s Appointment is Today @ 4:45 p.m.!)

There is documentation that the primary care physician and the patient have a good understanding of the risks involved and reasonable expectations that the patient will be compliant with all post-surgical requirements. (My First Dr.s Appointment is Today! And Yes I will be a good girl)

A contracted mental health professional has preformed a psychological evaluation to establish the patient emotional stability and ability to comply with post-surgical limitations. (Need to Schedule).

Sparkles · 02-11-2009, 10:07 PM

((((All By Myself)))) ((((Don't Want to Be All By Myself...)_))))

mistymee · 02-12-2009, 06:53 AM

Hey Sparkles.. welcome to TT.

Sometimes, if there are a lot of posts coming in at once, they drop off too quickly and get they get missed on occasion. Please don't feel too bad about the lack of response so far!

Sometimes, the approvals CAN be just that easy. Mine was as easy as pie.. when I had my first seminar, our doctors told us that BCBS was the best plan out there, as far as getting approvals. They are forward enough (so it seems) that they see the benefits of having people get healthy. A lot *will* depend on whether the company whose hired BCBS to administer the plan, as some have exclusions- my company was supposed to have WLS excluded, but our particular location made an error and it wasn't.. so I was the only employee in our worldwide company that was able to get it- none of the other employees at the MA location came close to needing it, and it HAD been excluded from all other plans. Our HR director was very disappointed because he needed the surgery himself but couldn't get it! He said based on my success (particularly getting off insulin and other meds) he was going to recommend to the higher ups to remove the exclusion.

In any case, it seems to me that though so many people sweat the approval process and many do hit roadblocks along the way- some of them significant roadblocks- there are still plenty of us that sort of breeze through. I hope if you're a good candidate that you have few hoops you need to jump!

Good luck.

Sparkles · 02-12-2009, 09:36 AM

Awww no worries I was just having a little fun with the song. I appreciate the feedback though. I am having troubles with my doctor. I am currently trying to find a supportive doctor that will help me do my 6 month requirement and that’s it.

MiladyB · 02-12-2009, 10:09 AM

Hi Sparkles. Welcome to the forum. Where in Michigan are you from?

I did not have BCBS but like Kel mentioned. I have heard from other people that it is one of the easier insurances to get approval from. I have Priority Health and it wasn't quite as easy. But that being said, once I had the criteria in front of me and knew EXACTLY what they wanted I was able to work with my PCP in order to make the approval happen.

What you do want to make sure of is what the insurance company considers a "medical supervised diet". For Priority Health, it meant going to a specific medical weight loss program. You couldn't just go through your PCP unless you lived in an area where none of the required weight loss programs were located. So that may be something that you will want to clarify before starting on your 6 month weight loss program.

You've taken the first big step and I wish you the best as you start traveling down this journey. And once again, welcome to the forum.

Sparkles · 02-12-2009, 10:32 AM

Quote:

Originally Posted by MiladyB

What you do want to make sure of is what the insurance company considers a "medical supervised diet". For Priority Health, it meant going to a specific medical weight loss program. You couldn't just go through your PCP unless you lived in an area where none of the required weight loss programs were located. So that may be something that you will want to clarify before starting on your 6 month weight loss program.

You've taken the first big step and I wish you the best as you start traveling down this journey. And once again, welcome to the forum.

Ooo my goodness. I never thought of that. I’ll call the insurance company and find out what they mean. Thanks for the helpful hint!

P.S. I am not from MI. But my insurance is. =)