Jump to content
×
Are you looking for the BariatricPal Store? Go now!

BCBS and BCBS Federal


Guest richardlisa

Recommended Posts

Guest richardlisa

I understand that BCBS recently accepted the Lap Band procedure. Is this for both BCBS and BCBS Federal? We have BCBS Federal & we just received our denial letter today saying he could have the gastric bypass surgery or gastric stapling procedures but not Lap Band or similar procedures. We're in TX & have been waiting patiently for the ins. to reply. Since they denied the Lap-Band, can we appeal?

Share this post


Link to post
Share on other sites

Boy, I don't know about B/C. Just wanted to give you my support. Go for the appeal! You may be pleasantly surprised. Look up Alex's sample appeal letter where she fought her ins. about the band vs. bypass and WON! (in old posts)

Why is it they always send those type of letter so you get them on a Frid. p.m. or Sat.? I think it's planned so you can't contact someone until the following week. Grrrrrr.

Share this post


Link to post
Share on other sites
Guest richardlisa

Thanks, we'll be asking alot of questions and probably alot of dumb questions but I'm not about to let that stop me from letting him get this surgery done. He has too many medical conditions already and no self-control so when the doctors found out that he wanted to do this they were tickled pink.

Share this post


Link to post
Share on other sites

Originally posted by richardlisa

I understand that BCBS recently accepted the Lap Band procedure. Is this for both BCBS and BCBS Federal? We have BCBS Federal & we just received our denial letter today saying he could have the gastric bypass surgery or gastric stapling procedures but not Lap Band or similar procedures. We're in TX & have been waiting patiently for the ins. to reply. Since they denied the Lap-Band, can we appeal?

Hi there,

BCBS is not one company, it's 52 separate entities and the plan that applies to Federal employees is something else. What one does has no bearing on what any others do, although they often mirror one another's policies.

But the answer to your second question is OF COURSE you can appeal!! The specific steps you will take depend on your carrier, employer, state, and so on, but you absolutely can appeal any decision.

The letter you received should give you some information as to an appeal procedure. If not, your employee benefits handbook or insurace contract (certificate of benefits) should have it. From what you say it sounds like the denial was not based on medical reasons, which to me says you have a better chance than might otherwise be the case.

Good luck!!

Share this post


Link to post
Share on other sites

I have BLBS in MN as a secondary insurance, and after eight months, they have granted coverage. I'm not sure if it was in response to appeal, but I suspect they followed Medicare and now cover banding.

Share this post


Link to post
Share on other sites

I have Blue Cross Blue Shield Federal for the Washingotn, DC area. It started covering lapband in January, if you are more than 100 pounds over your ideal weight. They covered the surgery I had in February. If you are planning to file an appeal, you need to folow the procedures set out on the health care booklet put out by OPM. For my insurance, the first appeal is with the insurance cimpany, the second is with OPM.

Share this post


Link to post
Share on other sites

I have Blue Cross Blue Shield Federal for the Washingotn, DC area. It started covering lapband in January, if you are more than 100 pounds over your ideal weight. They covered the surgery I had in February. If you are planning to file an appeal, you need to folow the procedures set out on the health care booklet put out by OPM. For my insurance, the first appeal is with the insurance cimpany, the second is with OPM.

Yes I agree w/Goldie. I have BCBS HMO OHIO (FEP). I had NO problem getting approved for my surgery I had 2/24/07. I'd also check the plan brochure, but appeal thru OPM and beware of the cut off dates for appeal. Alexandra had posted an EXCELLENT appeal letter sample some time ago on this site, you might want to check that out too. Good Luck, and I'm sending you good vibes!!!! Keep us posted!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×