I've got bcbs-they made me jump through hoops, trying not to pay for the surgery. It took me 3 years of going through 3 sleep lab studies, 6mo supervised diet, psychiatric visits (3), cardiologist, but I finally got them to agree. Everytime they would tell me one more thing, I would complete what they requested and they would say just one more thing-this was 3 years, but I didn't give up. Tell your friend good luck and be patient.

I got bc/bs and they did pay for my surgery. I had to do a ton of things, including having parathyroid surgery. I had to see a cardiologist, an endrocrinologist, a nutritionist for six months, a therapist for a psych eval, and had to have a host of tests. I had to see my PCP monthly for six months. BC/BS has a site that will give you all the details of what is required to have this surgery. It took me 11 months to get through all the hoops but I stuck with it and finally reached the end of the line and met all their requirements.

I too have bc/bs, and for me it was a piece of cake. First I got the recommendation of my GP who also refered me to the surgeon. Then the surgeon's office interviewed me and set me up with the requirements of my insurance company. I had two nutrition appointments, one psych appointment and a meeting one-on-one with the surgeon. All through these appointments I had to follow the post-op diet and was required to not gain weight. Once the surgeons's office okayed me they sent the paper work on to bc/bs and I was approved within a week. Viola! That's all there was to it for me. I had by bypass on August 29th.
Maggie

Although there are similarities from state to state, BC/BS allows each state to run on its own. I'm sure this is due to each state having their own regulations as to how insurance companies can behave.

The best way to find out what will be required for approval, is to call the number on the back of the subscribers card and ask the representative. They will be able to look up the info needed.
God Bless!

Janelle

I have BCBS, if you make an appointment with the surgeon for a consult they give you a complete list of what you need. In my case it was a chest xray, EKG Psych evaluation, nutritonist visit, diet history and reccomendation from my GP

From consultation to operating table was 2 months and 1 week for me, but I had to be persistent and I had documented all my co-morbitities by getting all my health problems addressed before talking to the surgeon.

I have that ins. Every place with that insurance can have different rules depending on what employer is paying for it. It was relatively easy for me. Just got an official weigh in and had to lose 5% of my body weight and get that officially written down by my doc. Do a pshyc eval, visit a dietician and get a physical and sleep apnea test. Now all this stuff had to be done at a specific place to be covered. A center of excellence.

As usual, the DS gang is right. First your friend needs to ask her human resources benefits person if the company purchased GBS when they bought insurance for their employees.

If so, she needs to contact the insurance company and find out what their rules are to be eligible.

Good luck!

man some of you had it bad with the insurance company's. i am a military wife and all of this is done on base, i did have a 3 month time frame, but that was because they wanted us to have 3 support group meetigs before surgery. i had labs, full physical, pap, psych, nutrition (one group and one 1 on 1), and the 3 support group meetings and that is all i had to do, but they really care at our clinic and make sure we know what we are doing before. glad i have tricare insurance.

I am also a navy dependent and mine is being done on base too. But my wait is much longer it used to be 2 years wait list I am now at 5 months. I do need to have nutrition classes and support group meetings. Also they have lots of info for us to go over. I am being patient because this is a miracle they even cover this surgery. I have been heavy for 14yers and a fewmore months is well worth the wait to have WLS. And to get healthier.