federal employee program BCBS

[Sweet927 0]

Well my surgeon has a set fee for the procedure as well as 90 day f/u...so I dont have any co-pays for 90 days ....my fills are included.

[RaeZur 0]

my first consult is monday, so I guess that will be a good question to ask then! Thanks!

[TurboDriver 2]

I have Fep BCBS PPO Standard...Looks like some people on here have the same thing, but not sure if it's HMO or PPO. I'm based in CA so I think it is 'handled' by Anthem Blue Cross...But I could be wrong.

I already went in for the initial weigh-in, seminar, and consultation and I got a call from the center today that my insurance does not exclude it, but they did say something about 65/35. Just curious, does that mean I have to pay for 35% of the total costs? Does that sound like what other people have heard?

I have a BMI of 40.0, but I think they miswrote it at 41.3. Either case, they told me that I need to get 5 years ( :biggrin: ) of medical records from my PCP (to document my weights). Then I need to get an upper endoscopy, and sleep study. Then they can put it together as a "package" and get an estimate for my out of pocket costs. Does this sound familiar either? It sounds like what I'm going through is more complicated than what others have. I don't have a problem getting the info (Been a BMI of 30+ for probably the last 20 years) but just curious...

Sorry for another question......Are there other fees that sneak up on you? In other words, 65/35....if that means I pay 35%...Then is that just the deductible and there are other fees on top of that, or is that probably it?

Reason why....When I spoke with the insurance person they briefly said that cash patients pay $16k and insurance gets a higher rate ($20k)....Keep in mind this is CA so costs are high here....Anyways...35%(20k) ~ $7000. I see lots of ads on this webpage for quite a bit less than that -cash- so I'm trying to do the math in my head. What I'm afraid of is that they have a good idea of what it's going to cost me, but they want me to invest more time in the program (e.g. getting the 5 years records, endoscopy and sleep study) so that I don't "price" other surgeons (And not waste time going through their process)

Thanks for any advice and input. Sorry this is so long.

Edited June 23, 2010 by TurboDriver
Added the part about the endoscopy and sleep study

[Cocoabean 430]

Turbo, you can find the brochure for BCBS PPO online, it should explain the 65/35.

I have BCBS HMO, my costs were $15 copay for office visits, including fills, and $100 for the hospital stay. That was in 2008.

[TurboDriver 2]

Thanks Cocoabean - You read my mind. I checked it out this morning, scanning for 65/35 and hit a good section about preferred vs. participating providers.

Looks like for my plan, participating providers are covered at 65%.

I've decided to switch to try being banded at cedar-sinai since they are a center of excellence, and I (presume) have surgeons that are preferred as well. I have registered for their first step (seminar/consult) on july 7th. Wish me luck! :thumbup:

[Alisomniac 0]

Update: Just found out today that I've one my insurance grievance, which means I can get a consultation with the surgeon, and hopefully have surgery approved. Now I just don't know how to get the next step going... Because I'm HMO... do i call my PCP to do whatever comes next, or can I call the surgeon directly for an appointment? Hopefully approval for the acutal surgery is a easier now that I have insurance backing up my qualfiication to see the dude

[Cocoabean 430]

Update: Just found out today that I've one my insurance grievance, which means I can get a consultation with the surgeon, and hopefully have surgery approved. Now I just don't know how to get the next step going... Because I'm HMO... do i call my PCP to do whatever comes next, or can I call the surgeon directly for an appointment? Hopefully approval for the acutal surgery is a easier now that I have insurance backing up my qualfiication to see the dude

Alisomniac, congrats!!!

You should be able to call the surgeon directly. The appeal result letter should state that you may now see the surgeon. Mine did. If not, call the surgeon to schedule and tell them what happened, they can confirm approval for the consult.

After my appeal for the consult, I had no other issues getting approval for surgery. That was my only hurdle.

Well done!!

[abraxasbear 16]

BCBS Basic apparently gave the preliminary approval, and I just got the appointment for my initial consult, psych, and dietician visits--all set for August 12th!

[Alisomniac 0]

Just got contacted with the surgeons office, and my info session is scheduled for 8-6-2010.... im hoping this process goes quickly- but am having a hard time finding people who have gone though LePort's office to give their experiences. i'm hoping the fact my BCBS appeal was successful means an easier overall approval for me... after all - to win the appeal I had to prove I was eligible for the surgery, and that's what the consultation is trying to establish too, right?

So far I only have a date for the info session (Aug 6th) but I'm hoping that I am able to move on to the actual consultation and other checks come quickly... my BCBS consultation approval was only valid through the end of September, so I know I'll at least meet with the surgeon by then!

[beergut 2]

I've got FED BCBS Basic and I'm pretty happy I don't need the 6 months supervised diet... I'm still in the info gathering stage, but having the right insurance is a huge hurdle for me. I'm hoping to get a consultation soon and start the process.

[RaeZur 0]

I have to tell you FED BCBS (I have BASIC) s probably the best insurance to have for this surgery. I started this process in mid May and have a surgery date of August 19.

My insurance has paid for everything with the exception of my normal copays. The only thing that I did have to pay for out-of-pocket was the Bariatric Center's Program fee ($500.00). Other than that I have had a total of 3 copays of $35.00 for doctor's visits (including the Psych Eval).

You just need to be sure that you use In-Network providers and get pre-certification (usually for the Psych Eval) when required. Fed BCBS likes to use their "Blue Disnction Centers" for the surgery (it makes the process go alot smoother and quicker) than just choosing some random Bariatric Surgeon.

Once I had all of my necessary paperwork completed (as well as labs and classes completed) I was approved over the phone in a matter of minutes. No pre-op diet required either, so that is a relief.

Edited July 24, 2010 by RaeZur

[Alisomniac 0]

Had info meeting, all was well, the office and staff were really nice, the process went smooth (except for the 200 pages of paperwork...yuck) and it looks like they are busy, yes, but it seems like they are moving us along at a pretty quick place. The only negative was that I got the feeling they were trying to sell the bypass.... they mentioned its advantages over the band several times, and seemed to focus somewhat more on the shortfalls of the band vs. bypass.

Other than that, I am hoping that I will be banded by Halloween... I have my "mandatory obligations" this next week or so, then final insurance approval paperwork should be submitted by 8/20.

New time-line

Info Session - 8/6

Psychologist - 8/9

Nutrition Class - 8/14

Doctors Talk - 8/16

Group Support - 8/16

Final request to insurance (8/20 ish... office said they'd submit as soon as I finished the above requirements)...

Approval??? September sometime??? (Im told BCBS moves pretty quick). Surgery hopefully by halloween!

[abraxasbear 16]

How long does the approval last--is there a time limit, before you have to go through the process all over again? I go in this Thursday for my surgical consult, psych eval, and dietician visit, but no matter how quickly BCBS moves, my work responsibilities mean I won't be able to schedule surgery until November.

[Alisomniac 0]

The approval for the consultation with the surgical group had a 90-day time frame on it. As I understand it, as long as you begin the consultation process with the surgeon by this date you're fine.

I had my Info session last friday, psych consult today, and will complete teh other 3 classes next week and am told the final paperwork will be sent to insurance to approve the actual surgery, and this could take 2-6 weeks depending on insurance...

after that you're at the mercy of your surgeon's schedule to the most part... IF there is a timeframe, I would expect it to be about 90 days again... but you should be fine as long as you are on the books, otherwise Id call insurance to extend if you have an issued-- i can;t see them making you re-do any of the classes/consults and they generally don't begin lab work / work-ups (xray etc) till just before the surgery since time can affect these more seriously.

I wouldn't worry... I'm told that when approved i will definitely have the procedure this year, and i'm hoping by the end of October, though this is a crunch and i'm not honestly expecting it with how busy my surgeon seems to be.

[Alisomniac 0]

Completed the final classes/pre-appointments (nutrition 8/14, group support 8/16 and doc talk 8/16), spoke to the insurance lady Tuesday and she said she'd submit "Today"... so now the waiting... i hear BCBC Fed is pretty quick, so hopefully I'll hear back soon