BCBS Fed

[tmx000 0]

I just got off the phone with customer service so I could find out my benefits and was told that after Jan 1, 2011 they where going to be tightening up their requirements for WLS and that in the furture patients will have to undergo supervised diet plans, ect, ect. The agent was a bit vague but now I am worried because there is no way that I will be having the surgery before that time. I could use advice about how to speed up the process.

[Momto3redheads 18]

I had surgery in 2009 and I had to have a listing of supervised diets, for mine under BCBS Fed. Course that was prior to the new sleep apnea testing requirement as I didn't have to have that done....but I just listed out my weight watchers timeframes and that sufficed for the monitored diet, they said.

Hang in there - hopefully you can get your stuff done before the new year....I have heard the oop costs for us will be higher on fills etc, after the new year. Bummer!

[abraxasbear 16]

For what it's worth, there's another BCBS Federal thread in this category, and the approvals are coming VERY quickly. Once your surgeon's office has everything in, it appears they are granting the approvals within 3 days, and in one case within 1 and a half hours. Mine (once it was resubmitted to the correct fax number---grrr) was approved about 26 hours after the documentation was faxed in.

So if you can get your paperwork in from the surgeon, you very well may get your surgery before the new year! GOOD LUCK!

[honk 780]

Have you met with the doctor's office yet? Many doctors expect that you loose a % of body weight before surgery. Depending on their expectations you may or may not be able to have surgery before the first of the year any way.

[tmx000 0]

Honk,

I can crash diet with the best of them, that and drink a gallon of Water right before the appointment. The problem is that I can never keep it off for long and always gain back the weight, it seem that when my pounds go away it is to find a few more friends. I am going to call the office on Monday to see what it is that I can do to hurry the process along.

[Nacol 76]

I just got off the phone with customer service so I could find out my benefits and was told that after Jan 1, 2011 they where going to be tightening up their requirements for WLS and that in the furture patients will have to undergo supervised diet plans, ect, ect. The agent was a bit vague but now I am worried because there is no way that I will be having the surgery before that time. I could use advice about how to speed up the process.

I just read the Federal BCBS Texas brochure and yes, they have definately tightened up...

Based on the changes, looks like I need to go under a 3 month medically supervised WL program, get nutritional counseling, see psychiatrist, show evidence of WL attempts one year prior (not sure if they will take Weight Watchers), have a diagnosis of morbid obesity for 2 years prior to the surgery, etc. The brochure is on their website now.

[Nacol 76]

To speed up the process or accomodate for the upcoming changes, my Patient Advocate has started me on the WL program, set up appts with the nutrionist/pscyh in order to have the surgery in Feb.

[tmx000 0]

Just an update, I go to my first Appointment on the 4th and also start seeing a nutritionalist on the 4th. I have the feeling that the surgeons office is going to try to hurry the process along, the wieght loss isnt going to be an issue because I dont have to starve for all that long and I do tend to drop the pounds very quickly (I also regain them just as fast). They have already checked with the Insurance company and IF the surgery is done this year they will cover it without all of the extra hoops, which I have actually met most of. The whole reason they have added them at all it to try to discourage people from getting the help that they need.:laugh: I think that in reality most of us are willing to do just about anything to cure us of the disease of obesity.

[Nacol 76]

Just an update, I go to my first Appointment on the 4th and also start seeing a nutritionalist on the 4th. I have the feeling that the surgeons office is going to try to hurry the process along, the wieght loss isnt going to be an issue because I dont have to starve for all that long and I do tend to drop the pounds very quickly (I also regain them just as fast). They have already checked with the Insurance company and IF the surgery is done this year they will cover it without all of the extra hoops, which I have actually met most of. The whole reason they have added them at all it to try to discourage people from getting the help that they need.:laugh: I think that in reality most of us are willing to do just about anything to cure us of the disease of obesity.

congrats, that sounds promising...

[burnsz 0]

Scary enough I have the same insurance. It approved me in less than 2 weeks and only gave me 30 days to do the surgery in. I had to jump through all those hoops just for the doctor to do the surgery. I think you will do fine I would just stay on them. My doctor actually called them and had the response with in an hour. Then they just had to wait for the paper work. Now if you are in TX the insurance told me it was going to be $75 but at the end of the day it was $1750 because they only cover 70% of the device. Just so you are aware there may be more cost. I hope it goes very well for you and you have the help soon. :sneaky:

[tinkerbellbeeve 1]

i had my surgery 12-19-8 and bcbs/texas did not pay for

anything,not even my blood work it was 1200.00

but i would do it again!!lost 102lbs so far

it was work every penny! around 15,000 out of pocket

its 300.00 for a fill

my doctor has left the area

so hopefully i will not need a fill anytime soon

good luck

[tmx000 0]

Just an update. I start my liquid diet on 1/13/11 and have surgery on 1/27/2011. Everything got approved without the trouble I was anticipating, totally excited.

[Puttingmyselffirst 1]

Congratulations! My paperwork will be submitted to BCBS Federal by the end of the week. I'm keeping my fingers crossed for a speedy approval .

[StacyS 2]

I am on BCBS-Fed and will be submitting my paperwork this month for approval and pre-certification. Are there any new requirements? Like 1yr supervised diet, etc? I have 6 months of documented supervised diet, but certainly not a year.... Any help would be great- in order to know what I'm up against!!!

[Puttingmyselffirst 1]

Stacy, I have gotten so much mixed info on the requirements. I think you will be fine with the 6 month diet. The insurance coordinator at my surgeons office is very experienced with BCBS Federal and says it's really not difficult to get approved. She says that they don't follow the written requirements extremely closely, they are more lenient. I hope she is right! I really want to get approved!

Good luck!