Blue Cross Blue Shield - Page 3 - ThinnerTimes

julie1971 · 04-01-2006, 03:56 AM

I have BC/BS of NJ--PPO, too. It took about 2 weeks to get my approval...I think that was with a little nudge from the surgeon's office because they wanted to be sure on scheduling. I only got the approval 10 days before my surgery, but I think the surgeon's office was pretty sure everything was going to be ok. They say they can take up to 30 days...but hopefully it won't take that long. I'm sure it'll all be approved, but it's nice to KNOW FOR SURE. Good Luck!!

Dave T in SD · 04-01-2006, 07:55 AM

Mine took all of 6 hours!

Dr. C's office really did a bang-up job!!

AThinnerSandyFor2006 · 04-01-2006, 10:25 AM

Waiting on approval is killing me. I'm suppose to transfering to Fl with my job in April.

Zenomia · 04-01-2006, 11:07 AM

Quote:

Originally Posted by AThinnerSandyFor2006

Waiting on approval is killing me. I'm suppose to transfering to Fl with my job in April.

Oh Man Sandy....I am sweating bullets for ya....They HAVE GOT TO Know something by Monday!!!!! I swear some insurance companies should be beaten!!

Still hanging in there for you!!

L

AThinnerSandyFor2006 · 04-01-2006, 11:15 AM

Thanks Z....I'm thinkin I'm gonna have to drive to Jersey and cut someone. My doctor's office didn't submit the paperwork until 3/30..nice, uh? Not sure who I have to stab first.

fatnomore67 · 04-01-2006, 07:16 PM

I have BCBS IL HMO. They are known to be the "best insurance in IL for WLS". This is from a nurse who works only on WLS patients and deals with all insurances. I got approved for a surgeon consultation within hours of the Dr. requesting it. After the consultation, once the paperwork reached my PCP, it took 1 DAY, yes ONE! Even my PCP was surprised since I was going to be a difficult patient and had to be open (not Lap).

Matthew
416/252/199
Open RNY 5-11-05

Shakiki · 04-02-2006, 07:19 PM

Quote:

Originally Posted by trachvaudeville

Is there any way to find out what the medical necessity criteria are? I keep getting the run around with Blue Cross and I'm getting sick of it.

I work in Member Services at the company, so not only am I going through the whole authorizaton process, but I quote benefits and Medical Management guidelines info to people all day

When you contact your local plan's member svcs dept, they should be reading directly from Medical policy when they quote the appropriateness criteria to you for this surgery. If you are getting a general answer like "the surgery needs to be pre-certified thru med mngmnt, have your doctor submit records...etc, Have a nice day" that is NOT a full benefit quote! The rep you speak with should be mentioning BMI/weight requirements, and the whole spiel. What you can do is call your local plan and either ask how to file for what's called a "pre-determination of benefits", or you can ask for the address to send a request for "medical appropriateness criteria or clinical review criteria." They will send you the information upon which the nurse case managers base their decision re: the appropriateness/necessity for the surgery.

Hope this helped guys!

Groovey kinda Love · 04-03-2006, 02:08 PM

Quote:

Originally Posted by AThinnerSandyFor2006

I'm wondering if anyone on this forum has had experience with Blue Cross Blue Shield. If so, I'd like to know how your experience went and how long did it take to get approval. I keep getting various answers from the reps at BC/BS everytime I call.

Hello Sandy,
I have bcbs and i fought to get my surgery for over a year. I was originaly seeking the duadonal switch, wwhich in my opinion is way better and for my medical needs it was necessary but I ended up getting the RNY LAP. I am happy that they paid for one of the surgerys but honestly in my opinion they are far from professional.... lets face it one would think that their attending physician would know what he is talking about and those nurses at bcbs think they know you better than your own doc. pretty crazy if you ask me. BUT I am now on the other side hoping and praying like everything that I didn't go through all that for nothing I have lost a significant amount of weight but I amm worried, I read an article on "the pain of regain after WLS" I hope I have nothing to worry about.

AThinnerSandyFor2006 · 04-03-2006, 03:10 PM

I'm beginning to think Satan works for BCBS or all the people I talk to there ride the little yellow bus to work..........

IpsieDixie · 04-03-2006, 03:15 PM

Hi,

I have BCBS of Massachusetts. Normally, my insuror will approve anyone with a BMI of 40 or above or anyone with a BMI of 35 and a co-morbidity such as diabetes or sleep apnea.

The insurance specialist at my surgeon's office wouldn't even submit my case without proof of a co-mirbidity, so I spent a night at a sleep lab, got dx'ed with apnea and bob's yer uncle! I got approved on first submission.

Good luck to you! Let us know aht happens.

Dixie