Approvals with BCBS Federal

[SleeveandRNYchica 1,155]

I think I can have mine at fair oaks or sentara

[PlBren 21]

@@PlBren

Hi there - I am on my husband's BCBS Fed and was sleeved May 26th at Bluepoint (inova Fairfax). I live in Alexandria, but was willing to drive as I really liked the surgeon and practice.

I also have a friend who submitted today on BCBS Fed - hoping she gets a fast answer! I was lucky and knew in 3 days.

So jealous!! I will be 3 days tomorrow and doubt I will hear anything. Even my doctor told me to not bug them until after a week. What was your BMI pre-surgery? Did you have any co-morbidities?

[PlBren 21]

Where are you having surgery?

Are any of you BC/BS Federal employee folks in the DC area like me?

I am....

SleevenChica -

Your profile says CO (I assumed Colorado). I am having the procedure done in Rockville. How about you?

No, I am in VA. I lived in Colombia when I had my sleeve. It's really CB. I just don't think back then CB was an option

I'm confused. What does CB mean? Where was your surgery?

[SleeveandRNYchica 1,155]

I lived in Colombia when I got my sleeve. I am being revised to RNY due to complications. New surgery in VA. Colombia the country

[babbs2299 15]

Wow! Lucky you ladies on the no co pay thing. I've got basic w/ PPO and had a copay on everything so far. It's gonna add up quickly. I'm figuring about the same overall price as SleevenChica is paying. Maybe a little bit more cause of the "weight loss university" I've got to be a part of for a year post surgery that insurance doesn't pay for. I think it's $699. Overall it's all still worth it IMO

[PlBren 21]

I lived in Colombia when I got my sleeve. I am being revised to RNY due to complications. New surgery in VA. Colombia the country

Complications on your sleeve? Anything we future sleevers should be concerned about - or ask our surgeons about?

Where in VA are you? My whole family lives in VA - Herndon, Manassas and Charlottesville.

[scoutmom 63]

@@PlBren

Hi there - my case was not a slam dunk. I had a low BMI (38)......I truly think the insurance coordinator can make all the difference in the world when it comes to getting approved. I chose my surgeons office in Fairfax even though he also had a practice in Woodbridge which was much closer to my house - all because the insurance coordinator was AMAZING! I owe my entire experience to her. I truly believe I would not had made it with the Woodbridge office.

My coordinator has been working with BCBS (and other insurance companies) for ten years - so she knows who to call and how to submit the paperwork in the best way possible to get the approval.

With all of the co-pays and fees, I spent about $1200. The main cost I didn't like is that you had to buy your pre-op shakes and supplements through the surgeon's office. They were Bariatric Advantage and a whopping $300. And it tasted SO bad, I went out and bought other shakes.< /p>

[SleeveandRNYchica 1,155]

@@PlBren

Hi there - my case was not a slam dunk. I had a low BMI (38)......I truly think the insurance coordinator can make all the difference in the world when it comes to getting approved. I chose my surgeons office in Fairfax even though he also had a practice in Woodbridge which was much closer to my house - all because the insurance coordinator was AMAZING! I owe my entire experience to her. I truly believe I would not had made it with the Woodbridge office.

My coordinator has been working with BCBS (and other insurance companies) for ten years - so she knows who to call and how to submit the paperwork in the best way possible to get the approval.

With all of the co-pays and fees, I spent about $1200. The main cost I didn't like is that you had to buy your pre-op shakes and supplements through the surgeon's office. They were Bariatric Advantage and a whopping $300. And it tasted SO bad, I went out and bought other shakes.< /p>

Who was your surgery with?

[SleeveandRNYchica 1,155]

I lived in Colombia when I got my sleeve. I am being revised to RNY due to complications. New surgery in VA. Colombia the country

Complications on your sleeve? Anything we future sleevers should be concerned about - or ask our surgeons about?

Where in VA are you? My whole family lives in VA - Herndon, Manassas and Charlottesville.

Here's my story:

I am almost 3 years post op from gastric sleeve surgery. My surgery was 10/1/12. I was a slow loser from the start. When I was ready, I was working out 5-6x a week. I saw my surgeon and nut at required times. They thought my progress was great. I had my surgery in Bogota. I lost 53lbs pre/post op from Oct 2012 until July 2013. We moved back to the US and I gained about 7lbs. We were living in a hotel and I started a new job.

We found out we were expecting a baby in Sept 2013. My weight loss slowed between July and August of 2013 leading up to pregnancy. I had a difficult pregnancy but gained weight just like I did in my pre-sleeve pregnancy. After my delivery in 2014, I noticed an increase in reflux and my weightloss was nonexistent. I consulted with a new doctor. He ordered a barium swallow. That showed a hiatal hernia and confirmed gerd. At that time the doctor told me he had several post pregnancy sleeve patients with dilated sleeves.

I had my follow up endoscopy which confirmed a nice size hiatal hernia and I have an angulated sleeve (it's twisted).The food is not exiting properly or timely. It causes the back up in the sleeve and the gerd. It is also like I have a pouch at end of sleeve.

I am in Woodbridge....

[elrios1 47]

I called and was approved today. It was sent monday and was approved yesterday but didn't call till today. If you guys don't call them they will not call you and you will be waiting to get a letter in the mail.

[PlBren 21]

I called and was approved today. It was sent monday and was approved yesterday but didn't call till today. If you guys don't call them they will not call you and you will be waiting to get a letter in the mail.

Can you share with me what Number to call? The insurance person at my doctors office said it wouldn't do any good for me to call that I'd just get a customer service rep who won't know anything until after the doctor is told.

[rln52 136]

Just call the customer service number on your insurance card. I called every friday for 2 weeks then started calling daily on the third week and found out i was approved 7 days earlier. but it was not in the system until then. Also a letter had not been sent to my surgeon or me. So just call!!

Edited August 8, 2015 by rln52

[elrios1 47]

Yes I called customer service number on the card

[PlBren 21]

Here is my update. Person in Dr office tells me she submitted everything electronically on Monday Aug 8th. I asked if I should call BCBS myself to check. She tells me I would only get customer service and they don't know anything.

I wait one week - call her and leave a message. She returns call and leaves me a message saying the insurance company says my case is still pending.

Not knowing what that means exactly and knowing how hard it is to get her on the phone, I call customer service for BCBS FEP today. They tell me they have nothing on record and no indication of any open case - which there should be since it has been 8 days. He suggested I have them double check.

So back on the phone to my doctors office. Explain my concern in a message. She calls back - repeats the pending comment and tells me how often she hears patients who have told her the same thing (that the insurance company says they have no paperwork). She tells me she has confirmation that they do have it: 1) a faxed confirmation that they got everything and 2) that she talked to the right people there (not customer service reps) who told her it was pending. She repeats that customer service doesn't know squat.

She then told me I would be the first person she calls when she hears something (which was a polite way of saying - stop bugging me).

Any of you other FEP folks - did you actually get any useful info in the first week to 10 days from customer service?

[Rose4 Life 19]

I have BMI of 38.8 and was approved. I have hypertension and arthritis which approved me.