Chrissy3104

What to expect??

Recommended Posts

I'm new to this site but I must say that it's AWESOME! It really feels like a family and community which is beneficial since we will all need each other throughout this process. 

I am at the VERY beginning stage of my decision to have bariatric surgery. My seminar is next Tuesday so I'm undecided about which surgery to have. I have BCBSNC through my employer. I've found that bariatric surgery is covered as long as it's completed at a Blue Distinction Center. It also states that I have to be morbidly obese (which i am). Does anyone here have BCBSNC insurance? What was your approval process like? My BMI is just over 40 but I have no comorbidities. Anyone else in this boat? Did you have to do anything else to be approved? Just trying to prep myself for what's to come. I really appreciate ALL feedback. Thank you all and God bless!!

Share this post


Link to post
Share on other sites

Even within the same insurance company individual plans can vary. What I can recommend is since your BMI just barely qualities you without comorbidities, whatever you do, don't lose weight before your intake appointment with the practice, and fight the usual instinct to do everything you can to minimize the number on the scale. This is one time where a higher number is to your advantage.

Share this post


Link to post
Share on other sites

I have no experience with BCBSNC Chrissy - just wanted to welcome you to our forum.

Share this post


Link to post
Share on other sites

You can have WLS with a high BMI and no other comorbidities; many of us were in this position.  As for what BCBSNC will require, you need to talk with the insurer.  BCBS is nothing more than a broker of a health plan you company purchased.  As a result, BCBSNC coverage can vary greatly from one employer to another.  As it depends on what was purchased by your employer, best to contact BCBS directly.

Share this post


Link to post
Share on other sites

I read my company-specific policy and the requirement is morbid obesity and a Blue Distinction Center. I should point out that I have definitely had failed weight loss attempts. I even took one weight loss product last year that caused me to have a grand mal (tonic clonic) seizure. It was my first one ever in life. Very scary! My neurologist said that the particular weight loss supplement was more likely than not the cause of it. I'm hoping all of this will help my case with the insurance company!!

Share this post


Link to post
Share on other sites
On February 25, 2016 at 11:02 PM, Chrissy3104 said:

I'm new to this site but I must say that it's AWESOME! It really feels like a family and community which is beneficial since we will all need each other throughout this process. 

I am at the VERY beginning stage of my decision to have bariatric surgery. My seminar is next Tuesday so I'm undecided about which surgery to have. I have BCBSNC through my employer. I've found that bariatric surgery is covered as long as it's completed at a Blue Distinction Center. It also states that I have to be morbidly obese (which i am). Does anyone here have BCBSNC insurance? What was your approval process like? My BMI is just over 40 but I have no comorbidities. Anyone else in this boat? Did you have to do anything else to be approved? Just trying to prep myself for what's to come. I really appreciate ALL feedback. Thank you all and God bless!!

Hey! I live in High Point and am using Wake Forest Weight Management. My doctor is Dr. Powell. I have BCBSNC the 80/20 plan. My approval process has been a breeze. My bmi was over 40 and I have no comorbidities. Once you have completed all of your appointments then they will send to insurance for approval. My surgery date is March 22 and I started this entire process December 4 2015.

Share this post


Link to post
Share on other sites

Wow Savannah that's great news!  Like I said my seminar is this coming Tuesday.  I work for BB&T so I wanted to know if we had any company-specific criteria.  I called BCBSNC BB&T customer service yesterday and she told me that their only requirement was morbid obesity and a Blue Distinction Center.  Savannah may I ask you if you had to have multiple appointments with anyone (nutritionists, psych, etc) prior to approval?  Also how long was it from your approval to your surgery date?

Share this post


Link to post
Share on other sites

I have to have the following:

consultation with surgeon

group nutrition appointment

exercise evaluation and RMR test (resting metabolic rate)

one on one nutrition appointment

psych evaluation

 

after those they sent the information to insurance for approval

 

I was approved in early February but I wanted to wait until March 22 for surgery. They might have been able to do it sooner. 

Share this post


Link to post
Share on other sites

Good to know!

Share this post


Link to post
Share on other sites
2 hours ago, Chrissy3104 said:

Good to know!

Forgot to mention, if you decide to go with the sleeve then you will be required to do an upper gi test. I'm going with RNY but the nutritionist mentioned that as a requirement. BCBS NC aka the state plan will cover both. 

Share this post


Link to post
Share on other sites

Thanks for letting me know. I'm leaning towards the sleeve. I do have acid reflux at times but nothing that I take daily medication for. I can take an OTC for it if necessary. I guess I'll have to speak with my doctor to find out if I'm still a candidate. Thanks Savannah!!

Share this post


Link to post
Share on other sites
2 hours ago, Chrissy3104 said:

Thanks for letting me know. I'm leaning towards the sleeve. I do have acid reflux at times but nothing that I take daily medication for. I can take an OTC for it if necessary. I guess I'll have to speak with my doctor to find out if I'm still a candidate. Thanks Savannah!!

You don't have to decide what procedure you want right away. I imagine it's best to decide what you want before they submit for the pre-authorization so they know what to ask for. The endoscopy will give you and your doctor information to help you make your decision. If you have reflux it could be due to a hiatal hernia, which can be repaired at the time of your bariatric surgery.

Share this post


Link to post
Share on other sites

thanks Wendy!

Share this post


Link to post
Share on other sites

welcome as you start your journey to a healthier you.

Be an informed consumer, read, ask questions, etc.

no one should go into an elective procedure poorly informed. It is your life on the table.

The information you read should not be junk science but from reputable sources, such as a medical school or a teaching hospital like Columbia, Mayo Clinic, etc.

Best....

Share this post


Link to post
Share on other sites

@savannah91 I just had my seminar this evening and it went great! Dr. McNatt did the seminar and he was very thorough. I've been researching this night and day for forever and I'm ready. He did mention that BCBSNC was the easiest insurance company to work with. I asked him how long he anticipated everything will take from start to finish and he said possibly 2-4 months. He said that they would call me within 1-2 weeks to set up my initial consult. My question is did you wait for them to contact you or did you contact them. I'm ready to get started but don't want to seem to impatient. How long did it take them to contact you? What are your thoughts?

Share this post


Link to post
Share on other sites
10 hours ago, Chrissy3104 said:

@savannah91 I just had my seminar this evening and it went great! Dr. McNatt did the seminar and he was very thorough. I've been researching this night and day for forever and I'm ready. He did mention that BCBSNC was the easiest insurance company to work with. I asked him how long he anticipated everything will take from start to finish and he said possibly 2-4 months. He said that they would call me within 1-2 weeks to set up my initial consult. My question is did you wait for them to contact you or did you contact them. I'm ready to get started but don't want to seem to impatient. How long did it take them to contact you? What are your thoughts?

It took them maybe a week from my seminar that I did online for them to call with my consultation appointment. I'd wait a week and then if they haven't contacted you then I'd call them. They have been super fast with everything! :)

Share this post


Link to post
Share on other sites

Chrissy, 

I have BCBS of NC State employee coverage and it has not been easy. I was denied the first time, because my doctor's office didn't wait for all of my records from other physicians to come in prior to submitting for approval. I was borderline at 39 with BMI and the only co-morbidity was Degenerative Disk Disease. I was so frustrated with the office that after much research I decided to go with a Blue Distinction group in Hickory, NC. While Dr. Hata's practice is wonderful and thorough, I was still denied due to height discrepancies. My PCP made an error on my referral letter and stated that my height is 5'6. I have never been 5'6 even though I would like longer legs. Anyway, it was an error. Dr. Hata is going to appeal, but I had to go today and be re-measured by my PCP and have a letter written stating they have measured me in my bare feet and got the height measurement of 5'4. I am scheduled for the 20th. Peer to Peer review should be today. Hoping it works out. The Nurse Practitioner and nutritionist feel as though the height shouldn't be an issue, because of the DD Disease, but the insurance coordinator doesn't agree. The wait and see is stressful.  

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...