federal employee program BCBS

[trishfish 1]

I was just curious if anyone had any experience using the federal employee BCBS? I'm just waiting on my approval and was wondering how fast people were approved...thanks! :thumbup:

[Cocoabean 430]

Hi Trish,

I had BCBS California HMO through FEHB.

I had to appeal my request to see the surgeon--the denial was from my medical group, not BCBS. After I won that, it took me a while to get all the requirements in order to submit to BCBS. They submitted in late November, I think. And I got word in Mid January that I was approved.

Best wishes!

Edited April 8, 2010 by Cocoabean
To add a detail

[happy55 2]

I have federal bcbs of N.C. and I was approved pretty quickly.

[Alisomniac 0]

My PCP says he faxed my referral in last Friday (BMI 44 - ick!), had have Fed BCBS CA HMO... hoping I hear back super soon! And that it is a POSITIVE response.

I'm so ready for this, and every day I wake up fat, I am finding new reasons to want this change... it's like making this decision has opened my eyes to all the negatives I've introduced into my live because of my weight.

[sam c 0]

I have federal bcbs of Texas. I got my approval with in a week and surgery within a month.

[Cocoabean 430]

My PCP says he faxed my referral in last Friday (BMI 44 - ick!), had have Fed BCBS CA HMO... hoping I hear back super soon! And that it is a POSITIVE response.

I'm so ready for this, and every day I wake up fat, I am finding new reasons to want this change... it's like making this decision has opened my eyes to all the negatives I've introduced into my live because of my weight.

Hi There,

I believe they have 30 days to respond. I had the holidays thrown in during mine, so it took 5-6 weeks before I heard.

Best wishes for a speedy positive response!

[Alisomniac 0]

Unfortunately I just got my denial letter today... so I am going through trying to put together an appeal and start on whatever requirements they are claiming I don't meet in the meantime. That way, if i get denied via appeal I will have the medical history necessary.

[Cocoabean 430]

Unfortunately I just got my denial letter today... so I am going through trying to put together an appeal and start on whatever requirements they are claiming I don't meet in the meantime. That way, if i get denied via appeal I will have the medical history necessary.

Oh, that totally sux! There are some good examples of appeals letters on the web. The book Weight Loss Surgery for Dummies also has some good advice. Also check out obesitylaw.com they are an advocacy web site that might be able to help, too, if you need it.

I was denied to see my surgeon for a consult due to lack of a 6 month supervised diet. I gave them weight watchers records and personal journal entries along with medical history and other diet attempts with weight losses and gains over the years.

I explained another diet would do little to help. I won the appeal. It still took ages to get the other tests and things done, but I didn't have to wait 6 MORE months for a consult.

Best wishes to you!

[Alisomniac 0]

Denial was 100% from the medical group, spoke to Insurance today, (FED BCBS CA HMO) and said it sounded like I was easily approvable on paper based on BMI requirement, told me to call the medical group and discuss with them, if that doesnt work, call insurance to appeal or file a greivance, since I have some documentation ....

here's what I have : 1 year of bank statements showing gym membership, 6-8 months subscription from Amazon for monthly Slim Fast shipments, a few scattered diet journal entries and weights, LONG list of exercise videos and diet books/magazines, health equipment purchases and a personal affidavit regarding the need for hte procedure. I also have blood test results stating that I am most likely insulin resistant. ... hopefully the appeal process goes smoothly.

[rebmommj 0]

I was just curious if anyone had any experience using the federal employee BCBS? I'm just waiting on my approval and was wondering how fast people were approved...thanks! :crying:

My approval should have only taken 2 weeks...but some paperwork got put on the wrong desk...so it took almost a month...but once the Dr. office called & got the verbal approval....went fast....banded within 2 weeks! I became a bandster on 4/22/10. Good Luck!

[DianaG 0]

I was banded in July,2009. I had a BMI of 47:blink:, and several co-morbidities. I have BC/BS Standard for Federal Employees and they did not require any supervised diet, etc. If you are told that one is required, it is not by the insurance company, it is required by your medical provider. BC/BS Federal Employees benefits are the same in ALL states. The only difference is whether you have Standard or Basic options

In fact, it was sorta hard to explain to my medical provider that just because some BC/BS insurance plans require the supervised diet, that was not the case with the Federal Employees Program. I actually took my copy of the Insurance Brochure we receive each year in to the Financial person at my providers clinic and showed them the requirements of BC/BS Federal. I am not aware of any changes between 2009 & 2010, but you can check your booklet and call the phone# on the back of your card. In fact, I called a couple of times just to make sure I was understanding everything correctly.

Once the clinic understood the difference in regular BC/BS and the Federal BC/BS and sent my medical tests, nutrition consultation,psych eval, etc. on to the ins. co. I was approved within one week!!

My BMI is now 37 and I feel 100% better!! So, good luck to you and please let us know how things go for you!

[Cocoabean 430]

Denial was 100% from the medical group, spoke to Insurance today, (FED BCBS CA HMO) and said it sounded like I was easily approvable on paper based on BMI requirement, told me to call the medical group and discuss with them, if that doesnt work, call insurance to appeal or file a greivance, since I have some documentation ....

here's what I have : 1 year of bank statements showing gym membership, 6-8 months subscription from Amazon for monthly Slim Fast shipments, a few scattered diet journal entries and weights, LONG list of exercise videos and diet books/magazines, health equipment purchases and a personal affidavit regarding the need for hte procedure. I also have blood test results stating that I am most likely insulin resistant. ... hopefully the appeal process goes smoothly.

My denial was from the medical group, too. I won the appeal on first try. My PCP said a denial by that group is standard. BCBS approved me with no problem! Best wishes!

[DianaG 0]

Great! Sounds like you have all the info ready to fight their denial! I am pulling for you..don't give up or let them bully you. I am amazed that the medical group would be the ones stalling. After all, they know that they are going to be paid by the insurance company for your surgery! Perhaps they are trying to hold out in a futile effort to get more money from you or your insurance!:smile2: Who knows? Either way, you have to jump through their hoops, but it will be worth the fight when it is over and you are banded!!!

Best of luck!

[Alisomniac 0]

My denial was from the medical group, too. I won the appeal on first try. My PCP said a denial by that group is standard. BCBS approved me with no problem! Best wishes!

Called insurance again today, I found my benefit guide and my BCBS HMO is different that the one the insurance lady advised me on - my policy does state some other criterion, and the only one I don't meet on paper (yet) is 'activley participated in a physician directed diet" (no time frame, but 3/29 he advise South Beach, and I have documenation showing weekly weight loss since that date- HA). Haven't been able to reach my medical group, but the main/only sticking point in their letter is that I do not have "medical necessity", and their lone statement is my referral did not show documentation of prior weight loss attempts". I was able to comb through diet journals, subscriptions, etc... to show a long history of weight loss & exercise stuff

(Gym memberships, online orders, Alli pills, cookbooks, etc...).. i also have a few recorded dates from the last 4-5 years showing weight losses and gains. Hopefully this will be enough.

I have made a new appointment with my PCP for two reasons - to reevaluate my documentation to adapt the referral/support the appeal, and to have more documentation for "medically supervised diet"... my first appt was 3/29 next is 5/25 and hopefully those two months will count for the 3-6 month diet requirement that seems to be the norm.

I've also solicited affidavits from friends and family to submit to medical group / insurance grievance if necessary...

Fingers crossed! :smile2:

[Cocoabean 430]

I also pointed out that the in 1991 the National Institutes of Health wrote a Consensus on Gastrointestinal Surgery for Severe Obesity that did not include a 6 month requirement for candidates for surgery.

Do an internet search for the document and include it with your appeal. But it sounds to me like you already have the diet aspect covered.

What a pain in the patootey!