Wellmark Blue Cross/Blue Shield Insurance?

Hey! Just wondering if anyone has Wellmark Blue Cross/Blue Shield Insurance through Iowa? If so, what tests, etc. did you have to go through to get approved? :confused2: Thanks so much!

Ashley

I am working on getting everything ready for the insurance company.
I attended a 3 hour seminar, met with the surgeon and nutrionist, went to two appointments with a counselor, had my doctor send over 3 years of records, attended a bariatric support group. Now my bariatric surgeon wants a letter from my doctor to the insurance company. I am hoping this is the last step. The big thing your insurance company is looking for is information about diets and converstations your doctor has had with you in the past 3 years.
Go for it.
carol

Thread Starter

I don't think I've really been told by my doctor to diet & exercise. She's never really given me a diet plan or anything like that. Does that mean I have to wait 3 years to get the surgery??

I have Fed Wellmark Blue Cross/Blue Shield of Iowa. Didn't have any problems getting approved.

Thread Starter

What requirements did you have to have? Did you have all your tests (blood work, EKG, stress test, psych consult) after your approval? How long did it take to get approved? I've had a meeting with my doctor, but go to the seminar on July 14th. She said she'd have my letter ready after my seminar.

I was approved about two weeks after the letter was send to Blue Cross, I had all the test and meet with the psychiatrist. The staff at Genesis, is great and will help you with every step.

Not at all but they will want to see what efforts you have made toward weight loss. The three years of medical records is just what my bariatric doctor looks through.

I had heard they are quick. Thank you for the encouragement.

Im also covered under Wellmark Blue Cross. I know it covers it, i dont really have the details yet. I havent even been to the surgeon yet. I'm really nervous and excited! Hoping to get it done in June or July! If you have heard or know anything about Wellmark, let me know! Im interested! I wouldnt like any bad surprises!

It's been six months and no surprises. I'm very happy with the way Wellmark pays. Good luck and for me LAP-BAND® surgery was the best thing I've did In six months I've lost 70 lbs and feel great. I recommend you start a vigorous exercise program and stick with it.

Hi,
My insurance with Wellmark went through in just one day. I am very pleased with them. I have had the best care with Dr. Teresa LaMaster's and her office team. She is with the Iowa Methodist bariatric center. I would love to share my experience with you if you want more informaiton. I had my surgery on August 14, 08 and have had 5 fills so far. I think one more fill and I will be right where I need to be.
If you have any questions, just ask.
carol

Hi everyone .. I'm new to the Forum! Some of the Genesis patients may recognize me .. my name is Lynne and I was a secretary there.

I can offer a little bit of information about the insurance part for ya.

#1. Wellmark Federal is completely different than general BC/BS Wellmark. Federal, for the most part, always approves.
#2. Wellmark requires a "worksheet" that is filled out by a secretary, and approved by your surgeon that gets submitted to insurance. The information that gets filled out basically is what you offered up on the packet that you filled out that you got at the Education seminar you attended about your diet history. They are looking for structured programs, such as Weight Watchers, Jenny Craig, Nutri-System, etc., and Physician & Dietician assisted programs. Diet and Exercise on your own is included, but IMO doesn't count.
#3. Insurance companies have certain co-morbidities that they "count" as needing a surgical intervention - they are: Cardiovascular Disease, Hypertension, Diabetes & Sleep Apnea. Although you may have problems with Depression, Asthma, Arthritis, etc. .. insurance doesn't count it. Period.
#4. You have to have a BMI of 40+ without co-morbidities to be considered a candidate, or 35+ with one or more of the co-morbids I listed.
#5. There are only a handful of insurance companies that do not require a letter from your Primary Care Physician detailing your health & weight loss efforts, Wellmark does require it.

Sometimes there isn't any rhyme or reason on why any insurance company may deny (IMO .. Wellmark is notorious for them), but you can ALWAYS appeal. Make sure you gather ALL information you can including all your medical conditions, diet attempts, etc.

Even if your denial is upheld, you're NOT sunk!! Call them and demand to speak to the person who upheld your denial ... you just may get approved!

Hi Lynne,
Didn't see ya the last time I was at Genesis, hope everything is going good for you. My next appt is in March with Denise, hope to see ya then.
Bob

Bob,

Unfortunately .. I was off from work for a MRSA infection and my FMLA ran out, so I lost my job at the Center. There should be a new secretary working there now, not me ;(

I really, really miss the patients! I loved watching their progress and rooting for the new one's to get approved, so it was pretty disappointing for me.

Oh well, whaddya do?

Lynne

Lynne,
Sorry to hear that. Whaddya do? you pray and believe everything will work out for the best and believe me it will.
stay in touch and I'll miss talking to you at the center.

Bob