BCBS- Federal

StacyS · February 8, 2011

Hi All,

I have BCBS- Federal and was wondering if anyone else has them and how hard/easy it was to get approved for VSG with them? Any advise or experience would be greatly appreciated!

Thanks,

Stacy

camille01 · February 8, 2011

Hi All,

I have BCBS- Federal and was wondering if anyone else has them and how hard/easy it was to get approved for VSG with them? Any advise or experience would be greatly appreciated!

Thanks,

Stacy

hi Stacy,

When I went to my siminar that was one of the insurances that was brought up in decussion

and yes they do pay for the surgery....the best way to fine out forsure is to call the insurance co and

ask personally but you must call the hospital where you plan to have the surgery and find out the

surgery code(i think it is called a CPT-CODE)the hospital where Im getting my surgery ,The cpt code for the Sleeve. Gastrectomy is 43775. If it is approved procedure that is for BCBS,

I have GHI and BCBS ,but bcbs is my hospitalization....I hope everything works out in your favor and good luck...

StacyS · February 9, 2011

Thank you! I know the Sleeve is covered but I've heard that it's terribly difficult to get approved at first. I have a co-worker who referred me to Dr and hospital who also has BCBS Fed, and they denied her at first.... so I was just curious to see if anyone has actually been approved the first go around since the new year and the new requirements.

Ricky · February 10, 2011

Hi Stacy,

In Nov., I was denied a revision from lapBand to VSG, based on that is was "investigational." I too have Fed BCBS. I am working on my appeal now.

I am curious though, since my denial was before the new rules..do I follow the new ones or old?? I am assuming the new, but I don't know.

I was just diagnosed w/a hiatal hernia and have wretched acid reflux if there is ANY fill in my band. I had lost just over 50lbs w/ my band, but have regained most of it since it's been empty. I too am interested in hearing anyone else's answer to your ?. Maybe we can be approved together?? What is your BMI??

Mine was just at 40 before my surgery and I am around 38ish now w/no comorbidities. I am sure w/my empty band I will be back at 40 soon.

Best of luck to you,

Erika

StacyS · February 11, 2011

Hi Erika! My BMI is right at 40! My surgeon told me NOT to lose any weight while I'm on the 3 month supervised "diet" with their nutritionist (a NEW requirement as of Jan 1, 2011 for BCBS- Fed). I'm surprised you have been denied for the revision! What was their reasoning for the denial? Do you have a good patient advocate with your doctor's office? If so, they could probably contact your insurance and get all the details for you!

I have a hiatal hernia and I was told by another surgeon (when I wanted to get the LapBand) that they would correct the hernia BEFORE putting the band in. Did your surgeon not do that???

My co-worker got approved for the sleeve after the second try and that was back in Oct 2010; so I know BCBS- Fed does approve the sleeve!

dentonpl · February 22, 2011

Hi Stacy,

I have the same insurance. I applied for the sleeve in 8/10. I was approved right away for the lap band and the bypass but denied the sleeve. I wrote an appeal letter and addressed each reason they gave for denying me. I sent it in 10/10. They claimed never to have received it so I resubmitted and sent it in registered mail in 12/10. I also included letters from all my doctors stating why this was the right surgery for me. I was approved in 1/11 and just had my surgery 2/15/11. My best advice is when you apply, give them as many reasons as possible why this is the right surgery for you. Then if you do get denied, don't just roll over. Fight for your right to pick what is best for you. Good luck!

Lisa

PS-I would be glad to share my appeal letter if it would help anyone.

Ricky · February 23, 2011

dentonpl- thanks for sharing your experience. I need to have my band removed as I have a new hiatal hernia and possible slip. Since I need to have it removed, I wonder if I have to meet all the new revision requirements. I would love to see your appeal letter. My email is crispene@yahoo.com.

BTW..how are you feeling since your sleeve??

Erika