blue cross blue shield

Melissa S · April 29, 2007

My primary has monitored my BP very closely for the past 8 months or so... and she knows I have followed a diet and exercise routine... I have since dropped my BP from 192/98 to 122/83...with no meds.

chefschoon · April 29, 2007

I have empire BCBS as well (But I am in FL, company I work for is in NY)....I did the same exact thing as you, and I was accepted in 4 days from submission.....however, a week later I got a letter in the mail of denial, then the next day I got an approval letter. They did the same thing to my wife when she had her c-section. 2 days after her emergency operation, we recieved a letter in the mail saying that it was not medically necessary and they werent going to cover it.....but then the next day we got a letter saying it was approved......

crazy insurance. I used to live in Albany so I know most of the people that work in that office of Empire.....

AngelaM · April 29, 2007

My daugher had Horizon Blue Cross and Blue Shields of NJ., a BMI of 51 and was approved in less than two weeks. Full Coverage. Alot of coverage depends also on what your employer's contract is. Our family gets free prescriptions because that is what my husband's company negotiated. Seems the higher the BMI the quicker you get an answer.

Melissa S · April 30, 2007

Empire BCBS of DE actually states in the coverage description that the BMI must be 40 but no higher than 50... of course 35 or so for those who have other weight related issues (Cardiovascular, high BP, severe arthritis...) .... and that is applied to all weight loss surgeries.

So, Chef.... you had a similar issue as I do, and you were quickly approved?

Melissa S · April 30, 2007

I just spoke with the surgical coordinator/insurance rep...she told me she faxed all the info to BCBS on Thursday and may hear something back today!! Keep your fingers crossed!!!!

airwayman · May 3, 2007

I was banded Monday. I'm now a pro and know it all.

smriggs · May 3, 2007

I have BC/BS of Iowa..the lap band is covered on my policy but only if your BMI is less than 50 and mine is higher. Even though my doctor has presented tons of evidence that after 5 years the weight loss for that and RNY is the same. So..i am attempting to get my bmi down by losing about 41 lbs. It stinks!

singdeborah · May 4, 2007

I have fepbcbs and was told it would go smoothly. I have received benefit notifications after the psych eval and after the labs, ekg, etc and they didn't pay. We called them several times and each time they said "yes, it's covered and they were going to take care of it". This is about three weeks later and it's still not been paid, we called again and they said again "we will take care of it". I really think they will, but it's a hassle. The person that answers the phone doesn't ever help us, we have to always ask to talk to a supervisor.

Anyway, thought I'd share my experience so far. I'm sure they will pay, but as I learned from another surgery years ago You have to challenge just about everything. Read your benefits and challenge them if they don't pay, when the book says they should.

I am waiting to hear from the surgeon now, they have to hear from bcbs an approval, so that should be done, if not. I'll call again.

Frustrated · May 4, 2007

Hi singdeborah,

As far as I'm aware, they have 30 days to respond to your claim. If it's only been 3 weeks, I guess technically they have a few more days. But it wouldn't hurt to call them again and ask for a status update. Make sure you take note of whom you speak with when you call.

Madine · May 4, 2007

Hi singdeborah,

I have fepbcbs and have not had my surgery yet. Did you have any co-morbid conditions; such as hbp, diabetes, coronary heart disease or sleep apnea and 6 month supervised dieting within the last 24 months? I have been told my bcbs, by one person, who said you had to have both requirements. Later another staff person, told me if I had co-morbid conditions that I would not need the 6 month supervised diet. I don't know who to believe or what to do. However, I think I might still give it a try.

Madine

singdeborah · May 5, 2007

Madine,

I have diabetes, hbp, sleep apnea, etc., all the co-morbidities and so far no one has said anything to me about doing anything prior to the surgery as far as a supervised diet. At least that's what I know right now.

ragdollx19 · May 5, 2007

Hi singdeborah,
I have fepbcbs and have not had my surgery yet. Did you have any co-morbid conditions; such as hbp, diabetes, coronary heart disease or sleep apnea and 6 month supervised dieting within the last 24 months? I have been told my bcbs, by one person, who said you had to have both requirements. Later another staff person, told me if I had co-morbid conditions that I would not need the 6 month supervised diet. I don't know who to believe or what to do. However, I think I might still give it a try.

Madine

I have a BMI of 42 with federal bcbs and did not have to do any diet or ANYTHING other than ask for approval through my surgeons office. I got approved in 3 days.

Phyllis S · May 5, 2007

I have BCBS OF MD through my hysbands employer Baltimore County Government. As was explained earlier, each policy is different with BCBs even within the same state. It all depends how much each company wants to pay for the policy

ragdollx19 · May 5, 2007

I have BCBS OF MD through my hysbands employer Baltimore County Government. As was explained earlier, each policy is different with BCBs even within the same state. It all depends how much each company wants to pay for the policy

True, but I believe all FEP BCBS plans are the same. They are all for Federal Employees.