BCBS federal anyone?

[beachwalker4rny 95]

Anyone know how much this statement in my benefits brochure will cost me for a two day hospital stay for gastric bypass? "You pay 30% of the plan allowance for agents, drugs and/or supplies administered or obatined in connection with your care."

Edited November 7, 2015 by beachwalker4vsg

[meltravlr 19]

Are you basic or standard? I have that same statement in regards to procedures for out patient services but fep blue (in Washington anyway) requires bariatric surgery be in patient . With basic that means a $125 per day co pay. Hope that helps.

[beachwalker4rny 95]

I have the basic, so as an inpatient it's just the co pays? It is confusing.

Thank you!

[meltravlr 19]

Yes. As long as you are admitted "in patient". Make sure that is how they classify you. If you go for an outpatient procedure and end up staying over for "observation", that is when you end up with that 30%... Which adds up quick. Had an incident of this a year and a half ago with a broken ankle. Luckily it got resolved, changed to "in patient" and all I had was my $125 co pay. I am currently awaiting my insurance approval and I expect to pay $125 co pay for hospital stay and I then I will have separate co pay for surgeon (can't remember for sure but I think $100). Anesthesia should not be a separate co pay tho- it's included with surgery cost. As far as I can tell (of course I may change my mind if they don't approve me) fep bcbs basic is about the best insurance to have for bariatric surgery. Good luck!

[beachwalker4rny 95]

Thank you for the info! My Dr. should be submitting for authorization in a few weeks. I also think the BCBS federal insurance is pretty great.

[beachwalker4rny 95]

Good luck to you as well!

[Miss Mac 6,262]

Retired V A, here. I went in early on a Monday morning and came home Wednesday evening. I think all I paid was about $300, plus a few $20 co-pays for my various follow-up appointments at the bariatric clinic. Even then I got a $140 refund. BCBS FEP is awesome. Once my packet was submitted, I was approved in two days. They will also cover the panniculectomy with proof of medical necessity, but don't expect a Tummy Tuck.< /p>

[beachwalker4rny 95]

Thank you!

[SleeveandRNYchica 1,155]

Retired V A, here. I went in early on a Monday morning and came home Wednesday evening. I think all I paid was about $300, plus a few $20 co-pays for my various follow-up appointments at the bariatric clinic. Even then I got a $140 refund. BCBS FEP is awesome. Once my packet was submitted, I was approved in two days. They will also cover the panniculectomy with proof of medical necessity, but don't expect a Tummy Tuck.< /p>

Retired V A, here. I went in early on a Monday morning and came home Wednesday evening. I think all I paid was about $300, plus a few $20 co-pays for my various follow-up appointments at the bariatric clinic. Even then I got a $140 refund. BCBS FEP is awesome. Once my packet was submitted, I was approved in two days. They will also cover the panniculectomy with proof of medical necessity, but don't expect a tummy tuck.

@@Miss Mac They are awesome. Did you read somewhere about the panniculectomy? I was wondering about that and couldn't not find info on it anywhere.

[NewLife1985 45]

Hi, I also have the Basic Option for BCBS Federal. Does anyone know if they require your surgery to be at a "Center of Excellence?" I have my first appointment with the Surgeon on the 18th and I don't want to waste time...

[beachwalker4rny 95]

Yes I think they do. Call the number on your card and ask though

[tdc 56]

Hi, I also have the Basic Option for BCBS Federal. Does anyone know if they require your surgery to be at a "Center of Excellence?" I have my first appointment with the Surgeon on the 18th and I don't want to waste time...

Hi when I called two weeks ago. They said I had to use a preferred doctor and hospital. (Not participating - they won't pay for)You get a extra discount for using a center of excellence.

[meltravlr 19]

Ok... Maybe I don't love federal bcbs after all... Was denied yesterday. So incredibly sad right now. ???? It took a bit of prodding to even get them to tell me why, but evidently they are very strict on the 2 year weight requirement. My first BMI of the 2 year requirement was 34.5. I was doing cross fit 4 days a week, roller derby 3 days per week and eating strict Paleo and finally lost some weight... Then I broke my ankle.. And gained it all back. So for a very short time I barely got under 35. Because I didn't get weighed for about 6 months after that (and that was a June weight... I would be looking at having to put my surgery off for a year in order to meet the requirements. Maybe this isn't the right thread for this... But has anyone else had this occur and won in appeal? Thanks.

[tdc 56]

Ok... Maybe I don't love federal bcbs after all... Was denied yesterday. So incredibly sad right now. ???? It took a bit of prodding to even get them to tell me why, but evidently they are very strict on the 2 year weight requirement. My first BMI of the 2 year requirement was 34.5. I was doing cross fit 4 days a week, roller derby 3 days per week and eating strict Paleo and finally lost some weight... Then I broke my ankle.. And gained it all back. So for a very short time I barely got under 35. Because I didn't get weighed for about 6 months after that (and that was a June weight... I would be looking at having to put my surgery off for a year in order to meet the requirements. Maybe this isn't the right thread for this... But has anyone else had this occur and won in appeal? Thanks.

I an afraid if the same thing. They are submitting my insurance this week. So we will see.

[NewLife1985 45]

@meltravlr

I'm afraid of that! I too have fallen under the BMI barely in FEB 2014. I haven't been submitted yet... What about if you go back further than 2 years were you above the 35 BMI then? Maybe that would work... It would hurt to ask