Question on Precertification

[stefgray 0]

Hi Everyone. My drs. office says I don't need to be precertified by my insurance - BC/BS Federal. I have met all of my prerequisites and they're ready to schedule me for surgery (YAY), but I'm worried that if it's not precertified I'll end up with a monstrous bill that the insurance won't pay. Anyone else have that happen?

Thanks.

Steph

[Iluvharleys 15]

Maybe a quick phone call to your insurance would tell you if it is covered or not. I think I would want to know first!

[nataliec 0]

I definitely would cover all my bases and call your ins co. But... if this is the federal govt. ins. I am pretty sure they are required to cover you by law if you meet the prerequisites.:faint:

[ragdollx19 1]

I also have BCBS federal and had this same conversation with both them and my physician’s office today. The insurance explained to me that they will not send a predetermination letter or pre-approval. What they will do is send a letter stating the surgery is a covered benefit based on the medical information your doctor provided and that it will be paid at 100% benefits. How this is different I don’t really know. My paperwork was submitted Friday; I called today to check the status, and got a phone call this afternoon stating it was approved. Where are you located at?

[stefgray 0]

I'm in Maryland. I e-mailed the secretary today and got the same info as you about not precertifying. So, she's trying to schedule me for surgery later this month - either 5/22 or 5/25. YAY!

[Jenn 0]

<p>I believe that you doc's office should know. They have more than likely delt with your insurance company before and know what is covered. My surgeons office knew the requirements for every insurance.

[Lisa H 0]

I too have BC/BS Federal Employee Program, and my Drs office said, "You do know you have the BEST insurance, don't you?" I didn't, but when I called one week after my Drs visit I was told I was approved! Just make sure your Dr is a preferred provider and you should be set! Good luck

[jackie506 1]

What is the BCBS Federal insurance if you don't mind me asking. Is it through your emplyer or something? I have never heard of that before.

[Big As Life 0]

Wow...ladies, that is great....I am so happy for all of you....I have never heard of an insurance company doing this, but sounds like that is typical for BC/BS Federal....CONGRATULATIONS TO ALL THAT ARE APPROVED....YOU ARE GETTING READY TO BE BANDED....

[ragdollx19 1]

What is the BCBS Federal insurance if you don't mind me asking. Is it through your emplyer or something? I have never heard of that before.

We are talking about the BCBS plan that is offered to Federal Employees and their families. I think even these plans can vary by state that the actual coverage is in but as of January 1st all of them started covering lap band w/o pre op diets or all of that.

[jackie506 1]

We are talking about the BCBS plan that is offered to Federal Employees and their families. I think even these plans can vary by state that the actual coverage is in but as of January 1st all of them started covering lap band w/o pre op diets or all of that.

Congratulations. I am trying to do my pre-op supervised diet AGAIN (I have done supervised diets in the past but not the last couple of years. It is SOOOO hard. My thinking is 'if I was able to do this sticking to calories thing in the first place I would not be seeking the surgery.' Am I right? Anyway, I am so happy for you that do not have to do this. I am starving!!!! I am so afraid if I do not loss some weight this way they will tell me that I am denied. UGHHHHHHHHHHH

[ragdollx19 1]

The office I went to kind of hinted at not losing a bunch of weight on the supervised diet because then they could say you can lose it on your own without surgery.

[stefgray 0]

Well, I'm set. The surgery date is May 25! YAY! I get my pre-op instructions tomorrow and will start getting everything together. My husband is a quadriplegic, so we have to do a bit of work to make sure that everything is lined up properly. My brother-in-law will stay with us until I'm able to do the things I need for DH again (about 5 weeks or so). Am off now to try to figure out the whole ticker thing!

[ragdollx19 1]

That is funny! I have the surgery on the 23rd! I also got a letter in the mail from BCBS today saying I am "pre-certified". Which of course they dont do! Blows my mind! It was very nice to see it in writing though!

[stefgray 0]

Congratulations on your date! I am so excited I can hardly contain it. I'm trying to get all of my stuff lined up before I go so that I don't have to worry. I'm sure I'll forget something, but will hopefully get the important stuff. I managed to clear my calendar for two weeks...no small feat! So, I'm getting there.

I also got the letter saying OK. But, I'm keeping in mind that it doesn't necessarily mean that they'll pay everything. I'm hoping for no battle on the back end.