Federal BCBS...no approval required letter?!

[becslivinlife 10]

I got a letter in the mail saying that fepblue no longer requires prior approval for vsg in patient procedures (after the office submitted for approval!). This is not what I have heard from others! When I went back and read the handbook it doesn't exactly say you need preauthorization, only that you need to meet the BMI, Psych Eval, three month nutritional requirements to be covered. It does, however, say that for any inpatient procedure you need precertification. Isn't this just notifying them of the procedure before you go in? Has anyone else had this experience? I don't know whether to rejoice or cry (if there is something else that needs to be done)! Calling the surgeon's office first thing tomorrow!!!

[Kaj 88]

I'm 13 days out and have Fepblue basic. After I had provided proof of criteria met, my Surgeon submitted and I got a letter from Fepblue saying I was approved and the approval was good for X number of days and have my procedure prior to that date.

[becslivinlife 10]

I'm 13 days out and have Fepblue basic. After I had provided proof of criteria met' date=' my Surgeon submitted and I got a letter from Fepblue saying I was approved and the approval was good for X number of days and have my procedure prior to that date. [/quote']

I have basic as well. I wonder if they changed it for 2013 because the letter says "we no longer require per approval". This seems to suggest a recent change. I just can't figure out why they didn't tell the insurance guru from my surgeons office when she called BCBS to verify.

[Kaj 88]

Maybe they change for 2013. I just looked at my letter and it was dated May 15th 2013. And it does refer to it as preauthorization. So I am thinking you are correct, but I would definitely call both the insurance guru at the Dr AND BCBS.

[becslivinlife 10]

Agree! The last thing I need is to be stuck with a huge bill! I am going to have a busy morning on the phone tomorrow morning! Thanks for responding.

[Kaj 88]

Agree! The last thing I need is to be stuck with a huge bill! I am going to have a busy morning on the phone tomorrow morning! Thanks for responding.

My pleasure. Fixing to call my supervisor and let her know I'm gonna need another week. Two weeks just didn't do it for this 60 year old woman. Need a bit more time to build energy back, I suppose.

[becslivinlife 10]

My pleasure. Fixing to call my supervisor and let her know I'm gonna need another week. Two weeks just didn't do it for this 60 year old woman. Need a bit more time to build energy back' date=' I suppose.[/quote']

I hope your energy picks up soon! Are you on soft foods yet?

[Lulu5 24]

I'm interested to see your outcome. I too have BCBS fep basic and will be submitting to the insurance company for approval in about 1-2 weeks.

[becslivinlife 10]

I'm interested to see your outcome. I too have BCBS fep basic and will be submitting to the insurance company for approval in about 1-2 weeks.

I will let you know. I have looked elsewhere online and some others are saying they aren't preapproving them either, but have not had problems getting covered post-surgery. Still others talk about approval letters. I wonder if some states will pre approve and others won't? I just can't figure it out.

[chinamama 104]

This is how they did it back in 2007, but this time around (in April) I had an approval letter.

[Kaj 88]

I hope your energy picks up soon! Are you on soft foods yet?

I've been eating soft mushy foods for about 3 days but in very small, limited quantities. I find if I eat "food", I have a more difficult time getting all my liquids and Protein in because I stay full for so long. Soup and Protein drinks are still my favorite "meals".

[becslivinlife 10]

Well, its true. I do not need preauthorization. Of course, they won't cover me if I haven't meet the requirements listed in the plan brochure. The hospital does the precertification the morning of surgery, so I am all set! My surgeon had an opening next Monday for some reason so I am on for 8/26!!

[Jerzygurl 372]

I got a letter in the mail saying that fepblue no longer requires prior approval for vsg in patient procedures (after the office submitted for approval!). This is not what I have heard from others! When I went back and read the handbook it doesn't exactly say you need preauthorization, only that you need to meet the BMI, Psych Eval, three month nutritional requirements to be covered. It does, however, say that for any inpatient procedure you need precertification. Isn't this just notifying them of the procedure before you go in? Has anyone else had this experience? I don't know whether to rejoice or cry (if there is something else that needs to be done)! Calling the surgeon's office first thing tomorrow!!!

NJ BCBS Horizon Direct Access is pretty much the same. I have to do three months of doctor's office visits/counseling/evaluations. My first doctor visit counts as one, and my two NUT sessions count as the 2nd and 3rd. The only key is that the 2nd and 3rd sessions must be scheduled in separte months. I'm scheduled for the 1st NUT 09/11/13 and the 2nd 10/01/13..and then hopefully I can have surgery by the middle of October. Doc said probably by Oct 15th...