BCBS Federal Employee Program Basic

[Bri24 16]

I started this process back on June 16, 2016. I was denied first in August of 2016 then again in December of 2016 after I tried to appeal by myself. After that I was getting frustrated so I decided to use Lindstrom obesity advocacy appeals. They sent out the appeal letter to OPM on March 9, 2017 and I was approved on March 17, 2017. I just wanted to say if your having a hard time do not give up hope! Also you might want to talk to them if you have been denied as well.

[Angelcharm 13]

Hi there,

Did you ever found out the reason why you are being denied? I am currently going through the process now and I am terrified of being denied. I started my 3 months with the nutrionist and turns out in the first month I went away on vacation for 10 days in which I had a significant weight loss so her words to me was to try to do whatever I can now to loose what I gained. I am terrified but I know is my fault

[Bri24 16]

7 hours ago, Angelcharm said:

Hi there,

Did you ever found out the reason why you are being denied? I am currently going through the process now and I am terrified of being denied. I started my 3 months with the nutrionist and turns out in the first month I went away on vacation for 10 days in which I had a significant weight loss so her words to me was to try to do whatever I can now to loose what I gained. I am terrified but I know is my fault

Hi!

In the first denial letter they stated that my bmi was not high enough(it was 37 at the time), and I did not have comorbidities such as sleep apnea, hypertension, or diabetes. In the second denial letter they stated they would stand by their first decision. However if you read their operative language carefully they do not state that one has to have those exact co-morbid conditions.

I would not get too discouraged about the weight gain, my bmi has been moving around the 30s for awhile, and when I was searching googled I do not have some of the co-morbid conditions that people were listing. So I gained weight intentionally to get my BMI in the forties( and I did that during my 3 months of supervised diet). Even when I did get my BMI to 41 they said, I do not have any comorbidities, which I do, so they chose to deny me that second time.

I called every day and the main thing they are looking at is do you have any comorbidities or has your BMI been in the 40s for two years. If you get denied I will be happy to help you through the appeal process.

[Angelcharm 13]

Thank you Bri. I really appreciate it. This means the world to me right now.

[Bri24 16]

On 4/19/2017 at 1:33 PM, Angelcharm said:

Thank you Bri. I really appreciate it. This means the world to me right now.

No problem! I know how nerve wracking it can be waiting around. Good Luck! Please keep me posted I hope you can get approved on your first try.

[Angelcharm 13]

Thanks I will.

[Angelcharm 13]

On 4/20/2017 at 5:40 PM, Bri24 said:

No problem! I know how nerve wracking it can be waiting around. Good Luck! Please keep me posted I hope you can get approved on your first try.

Bri I just wanted to share the good news. My file got approved today.

[Bri24 16]

20 hours ago, Angelcharm said:

Bri I just wanted to share the good news. My file got approved today.

YAY I'M SO HAPPY FOR YOU!!!! Do you have a date yet? I'm 10 days post-op and I'm already down 23lbs. This is so worth it. I'm so glad you get to go this journey too! I hope we can keep in touch and keep each other motivated throughout this life change.

[Angelcharm 13]

Hi Bri. I should have my date by Tuesday. How was the surgery? We have to push each other

[nzuribelle 0]

Was the surgery excluded from your policy? It's excluded from mine but I'm in the middle of an appeals process.

[travelergirl 142]

I'm a fed with GEHA. They require six months of supervised weigh ins. My bmi and comorbodities checked all the boxes. I still got a denial letter first. Got the approval letter a week letter. My doctors office took care of it all.

Sent from my SM-G920V using BariatricPal mobile app

[nzuribelle 0]

I'm a fed with GEHA. They require six months of supervised weigh ins. My bmi and comorbodities checked all the boxes. I still got a denial letter first. Got the approval letter a week letter. My doctors office took care of it all.

Sent from my SM-G920V using BariatricPal mobile app

Was the surgery excluded from your plan? I know I read in the Clause that it's excluded unless medically necessary and it would be determined by the benefits administrator. My surgeon's office educated me in the whole process . That it would be denied at least 3 times before it actually gets approved but I feel the info they gave me is very vague. I did the 6 months weigh in and everything else. Now I'm just waiting on the approval. They say anywhere from 30 days to six months ! How long did it take before you got your approval? Congrats on getting approved by the way!

[Bri24 16]

9 hours ago, nzuribelle said:

Was the surgery excluded from your policy? It's excluded from mine but I'm in the middle of an appeals process.

No it was not excluded from my policy. It said you had to have co-morbid conditions or have a bmi of 40

[Angelcharm 13]

Not on mine.

[Keenikwe 82]

I have BCBS FEP and my program mistakenly thought I was compliant after 3 months... I got denied and told to do the full 6 months. I have my final weigh-in/NUT appt in 6 days. Then I'll be able to see how long it takes to be approved; hopefully! Crossing my fingers!