What were your insurance company requirements for approval? This is a discussion on What were your insurance company requirements for approval? within the Insurance & Financing forums.
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04-01-2008, 01:46 PM
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#1 | | Patiently Waiting...
Join Date: Jan 2008 Age: 28
Posts: 98
City: Dallas State: Texas | What were your insurance company requirements for approval?
Who's you're insurance company and what were their approval requirements for the surgery? 
__________________ ::::::::::::::::: NOT BANDED YET ::::::::::::::::::
(Looking for a new doctor in the Dallas Area)  DENIED 3x! - 2/15/08, 2/22/08 and lastly 3/25/08...employer has WLS exclusion and will absolutely make no exceptions....  | 
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04-07-2008, 10:58 PM
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#2 | | Registered User
Join Date: Mar 2008 Age: 40
Posts: 145
City: EAST WINDSOR State: CT |
My nutritionist walked me through. She had all the insurance info for me. All insurance companies are different. I had to be on a low calorie diet for six months. My friend had to follow a low GI diet for a short amount of time. I had to document behavior changes. I was required to have a phyc exam. I had to see a pulmonologist(sp) and maybe another - cant remember. After I completed it all, I was approved. I found all the requirements at my insurance companies web site. I searched the articles for lap band. Good luck
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 Dee
Banded 3/25/08
First Fill 2.6cc's-4/1/08-No restriction  | |
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04-09-2008, 09:13 PM
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#3 | | working on a new me
Join Date: Apr 2008
Posts: 44
State: michigan |  I have BCBS community blue PPO, I went through a bariatric center that was contracted with my insurance company so it made everything so much easier. my bmi was over 50 so that made me not have to have any documentation, just needed a psyche eval..intl consult was 4/7, eval is 4/17...center said that i should be banded by the end of may.
__________________ Nothing tastes better than SKINNY 377 / 340 / 299 / 150--start wt/surg wt/current/goal intl consult-4/7/2008--done lap band surgery-5/07/2008
Last edited by new_jewel; 04-10-2008 at 08:51 PM.
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04-10-2008, 11:42 AM
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#4 | | Registered User
Join Date: Oct 2007
Posts: 868
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I have bcbs of Minnesota and was a cake walk:
1) 6 month dietitian appts
2) Physc eval
The rest the surgeon required. took 1.5 days to get approved after submitting pre auth.
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04-10-2008, 11:46 AM
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#5 | | Token atheist / moderator
Join Date: Oct 2005 Age: 32
Posts: 6,211
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I have one of the UHC PPOs and I needed a BMI 35+ with 2+ comorbidities or BMI 40+ (very standard). That was it.
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-175 pounds
Banded March 1, 2006
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04-10-2008, 03:04 PM
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#6 | | Registered User
Join Date: Apr 2008 Age: 40
Posts: 8
City: Forrest City State: Ar |
Does anyone else have federal bc/bs? I have heard it pays the best, anyone out know from experience?
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04-10-2008, 03:06 PM
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#7 | | Registered User
Join Date: Oct 2007
Posts: 868
| Quote:
Originally Posted by 3m'smom  Does anyone else have federal bc/bs? I have heard it pays the best, anyone out know from experience? |
Ragdollx19 does I have talked to her in the past.
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04-10-2008, 08:13 PM
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#8 | | Waiting for restriction!
Join Date: Mar 2008 Age: 34
Posts: 153
City: Gulfport State: MS |
insurance ---Anthem Blue Cross Blue Shield VA (PPO)
requirements ---a letter of medical necessity from surgeon
APPROVED IN 24 HOURS!!!! 
__________________ Annika ShrinkingFriendsBlog Banded -- 5/09/08:biggrin2: Size 20/18/*16(by 1st day of school- 8/6/08)*/10 
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04-15-2008, 03:49 PM
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#9 | | Patiently Waiting...
Join Date: Jan 2008 Age: 28
Posts: 98
City: Dallas State: Texas |
Cool...thanks for the info guys! I might be getting a new job but I don't know who they have they're insurance with just yet. I'm just trying to get an idea of who has dealt with what company and what their experience was like so when I get my new insurance I might be able to have an idea of what I'm up against again. I just hope this new place doesnt have a dang exclusion like my current job does. Dont even get me started on that....lmao!
__________________ ::::::::::::::::: NOT BANDED YET ::::::::::::::::::
(Looking for a new doctor in the Dallas Area) DENIED 3x! - 2/15/08, 2/22/08 and lastly 3/25/08...employer has WLS exclusion and will absolutely make no exceptions.... | |
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04-16-2008, 08:46 PM
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#10 | | Registered User
Join Date: Apr 2008 Age: 34
Posts: 9
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I have UHC and they require the BMI of 35+ with at least 2 comorbidities. Do you know if they will still approve a person who is hovering at 34.9-35.3 with 3-5 comorbidities? I know it varies from division - division. I'm just wondering how anal they are about the BMI.
Thanks,
Melissa
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04-18-2008, 01:31 AM
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#11 | | June 6,2008 is the date!
Join Date: Apr 2008 Age: 44
Posts: 16
City: Kennesaw State: GA |
Hi ya'll! Just joined this thingy and am keeping my fingers crossed that Blue Shield of CA will make me a happy girl in a couple of weeks. I know that I had to get a phsycological, medical, surgical and dietary evaluation, but no word yet on if I'll have to get the 6 month diet thing. Gosh I hope not!! I've been going to weight watchers for years, but never was able to stick to it. I tossed all the books I had, and simply don't have records of all the other diets I've tried. I did a weight loss thing with a doc in Vegas when I lived there, but I don't think he's even around anymore. Does anyone have any experience with BS of CA PPO? Please tell me that it was okay and didn't require 6mo of diet records. My BMI is 41 and I have arthritis, bursitus, along with ruptured discs in the back, sleep apnea, depression, and more. No high blood pressure or heart disease, although it's in my family. Someone tell me that BS of CA will be easy!!! I'm worried!  | |
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05-13-2008, 06:10 PM
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#12 | | June 6,2008 is the date!
Join Date: Apr 2008 Age: 44
Posts: 16
City: Kennesaw State: GA |
I was approved yesterday for the Lap Band proceedure!! Now I'm scheduled to have it done on June 6th!!!!!  | |
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05-13-2008, 08:40 PM
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#13 | | Registered User
Join Date: Apr 2008 Age: 34
Posts: 9
| Yea!! Peace Dove!
Way to go, Peace Dove!
I am so happy for you! You go, girl!!
Congratulations!
Melissa  | |
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05-14-2008, 06:15 AM
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#14 | | Registered User
Join Date: May 2008
Posts: 435
State: Virginia |
I'm with United Healthcare.
I needed the psych eval (which is standard with my surgeon anyway). Their requirement with no comorbidities is BMI above 40, I just made it with a 41. My surgeon submitted the required information and I was approved in about a week and a half.
__________________  BMI Countdown: start 40.2, down to 33.6 Banded: May 30,2008 When people are motivated, it's easy to accomplish the impossible... ...And when they're not, it's impossible to accomplish the easy. -Bob Collings | |
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05-14-2008, 06:31 AM
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#15 | | Registered User
Join Date: Apr 2008 Age: 34
Posts: 9
| Congratulations, Jodi!
 Congratulations, Jodi!!!
I truly hope I have the same success and luck as you with United Healthcare. I really do. However, I'm scared to death I won't, since my BMI is under 40. Don't get me wrong. I have several comorbidities. I just don't have the 5 yr. PCP 5 yr. documented BMI/weight history. I had my Chiropractor submit a 5 yr. history. I really hope they accept it. Please pray for me and keep your fingers crosed for me!
Thanks,
Melissa
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