federal employee program BCBS

[Momto3redheads 18]

I have federal BCBS...as does my mom...we were both approved within 6 weeks from the psych eval being sent in....keep at it!

Good luck!

[Alisomniac 0]

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!

Thanks for the article (and supprt) Cocoabean...

and I just noticed you are about a sneeze away from your (and my) goal weight! CONGRATS! I'm hoping my doctor/medical group (Greater Newport Physicians) agrees with you.

How did you go about choosing a surgeon? My doc put a specific name on the referral (and seems very reputable), but I'd still like to have some control in the choice, even If i do choose the same dude.

[Cocoabean 430]

I went with my PCP's choice. He said he was who he would choose for himself. In fact, he did about a year after my surgery he had gastric bypass done by my surgeon. I'd hope your PCP would be open to referring you elsewhere if you do not like his first choice. I had a choice of two in my HMO, but liked my PCP's first choice so well I stuck with him.

I went to my surgeon's info seminar before my appeal was done. His are free. My hubby came with me. We both really liked him, so I was very happy when I won the appeal!

It sounds like you have all your ducks in a row. I also mentioned in my letter that I want the surgery so that I can have a relatively normal life, and take part in daily activities with my family. I spoke about how obesity affects the quality of my life and limits my activities.

The package I submitted was probably 15-20 pages. It was a lot of work to put together, but very worth the effort!

Keep us posted!!!!

[RaeZur 0]

I have BCBS Federal Basic, I was told that a BMI or 40 or greater or 35 or greater with two co-morbid conditions are the only requirements, no supervised diet..the only other criteria are the ones set forth by the NIH (which include the psych Eval.)...I called them last week...Looks like I will only be paying $100 per surgeon in copays and $150 per day at the hospital up to $750 and of course the normal copays for all of the pre-op and post-op doctor visits...which is way less than paying for diabetes or heart disease later in life!! Hoping to get my approval in JUNE, wish me luck!

[brittu 42]

It's not quite the same but I got a denial for lap band removal (mine slipped) within 5 days. I appealed and it took 9 months for them to approve removing the band. Then it's been another 7 months since I appealed to Washington DC for a revision. Appeals are supposed to be closed within 60 days. So in my experience they've been super fast on the denials and criminally negligent on the appeals.

Britt

[RaeZur 0]

Does anyone have any experience with Sentara Norfolk General and FED BCBS of VA? I am right at a BMI of 40 with no known co-morbidities.

[brittu 42]

You should be just fine. I've been fighting the OPM for many months over a revision. In what they've written to me it's pretty much a done deal with a BMI 40+. They've even indicated if I gain to 40 they'll change their minds bout my revision (grrr).

I don't think you'll have any problems at all.

Britt

[RaeZur 0]

I guess what I am concerned with is do they require your BMI to be OVER 40, ie 41. Because I told Sentara at my seminar that I was 233 (which was the last time I weighed myself) AND that is a BMI of 40 but they told me that my weight was not enough unless I had two co-morbidites.

I actually went home and weighed myself with clothes on and I was 241 that night. When I called to schedule my 1st consult I revised my weight with them. They said that was better, a BMI of 41. Well now, I have weighed myself nude and I am 238, BMI 40 again. So, I am litterally trying to gain lbs to make sure I am over BMI of 40 when I go in there on JUNE 1 for my first consult.

blah..I am so frustrated...

[Cocoabean 430]

Mine states greater than 40 or 35 to 40 with 2 comorbidities. Your plan brochure should be pretty straightforward.

Insurance Programs has the plan brochures for 2010.

[RaeZur 0]

Now that i read mine tat is what it says. Just a question do they weigh you with or without your clothes on??

[Cocoabean 430]

My surgeon weighs with clothes on, but shoes off. I have read of some who take weights with the patient in a gown. Make your appointment later in the day, you will be heavier. Wear jeans and a sweater, too, if you are allowed to weigh in clothes, might as well go for it!

Best wishes!

[dolphingirl422001 1]

I also have federal bcbs and have heard different info regarding the waiting period. What is the waiting period, not seeing one in the book?? I have basic coverage. I went into the seminar today and they just had us write down our weight, height and bmi. Said they would call in a week or so and let us know if our insurance would cover it. Was shocked they didn't weigh us. I am wondering once they call and say if approved what the next step is. Have heard there is a 3 month, 6 month and no wait. Hoping to hear I am approved, not sure where to turn next if not. :tongue2: Love reading all of the insights and information on this site~ so informative!

[Becca29 0]

Hi. I have the BCBS FEDERAL Basic plan..which is the best in coverage. Basically covers 100 percent. I have been to the seminar, met with my surgeon, just had my psych eval nutritionist and physical all in one day at the surgns office. From everything i ready, they do not require a sup diet. if you are above 40 bmi then they do not require one. I am only a 37 and it says nothing in the brochure about a sup diet just that you have to have comorbities.. A lady from my surg office called after my initial appt and told me that I have to do a 3 month sup weight loss. I was very surprised but i went ahead and started it anyway. which i am in the middle of. So last week i got another call from their office and they said that it looked like i have met all the requirements and the lady i spoke to before made a mistake and i didnt need a 3 month diet. So yesterday is when i did all the preop stuff(psych, nut, phys) and they told me it would take a few weeks to get all that info compiled into a letter for insuraance and i should hopefully hear something within 3 weeks if im approved. What i have heard from others and i have checked ALOt believe me,,,is that BCBS FEDERAl (FEPBLUE) is super fast in there approvals. some people have told me they got approved in 2-3 days. Lemee know if this helps...i am super excited and ready for this journey..sounds like we are kinda in the same boat! Good luck with everything!:Dancing_biggrin:

[Sweet927 0]

I have the same fed bcbs basic, no co moribs, bmi was 40 was apprvd in three weeks aftr surgeon submitted paper work..surgery was 5~14..

[RaeZur 0]

I was wondering, with FED BCBS Basic, do you have to pay an extra fee for fills? Or is it just considered a normal copay?