Help please...federal bcbs prior approval

[jbrad71629 2]

:help:Hi all

I have fderal bc/bs and am trying diligently to get them to pre approve my lap band surgery. They keep telling me to have the surgery and then they will review it for medical necessity. Has anyone else had luck getting them to pre approve this? My surgeon will not do the surgery without it, which I can understand that he can't take the risk of not getting paid. Pleas help me if you have had experience with this, as I am at my wits end.

[cfred 2]

:help:Hi all

I have fderal bc/bs and am trying diligently to get them to pre approve my lap band surgery. They keep telling me to have the surgery and then they will review it for medical necessity. Has anyone else had luck getting them to pre approve this? My surgeon will not do the surgery without it, which I can understand that he can't take the risk of not getting paid. Pleas help me if you have had experience with this, as I am at my wits end.

Hi jbrad,

I also have Federal BCBS.. I was approved for my surgery in no time. I had my surgery back on 5/10/07.

If you have a BMI of 40 or over then you should have no problem. They to said that they wouldn't preapprove and would wait until after the surgery. I was a little worried about that but it all turned out GREAT! As a matter of fact, my Dr's office was not worried one bit about the approval. Maybe you should find a new office that is more familiar with the Federal plan. From what I understand, it's one of the easiest to get approved with.

[jbrad71629 2]

Thank you for the info. I have piched such a fit with BCBS that I think they are going to give me my prior approval, just to shut me up... I would hate to swap surgeons as the one I have chosn is by far the most experienced in our area.

[cfred 2]

Honestly, if you meat their "criteria" then you should not have a problem at all! I haven't had one claimed denied and refiled. They have all been approved from the get go!

Good luck to you!!!

[jbrad71629 2]

I got it!!!!!!! I am so excited, my surgery is scheduled for 11/16/07. Thank you so much fo your help.

[shadst83 0]

Do you guys have BCBS fep basic or standard? I was told that they do pre-approve with basic in some cases, but not with standard. What's the deal???

[ragdollx19 1]

I was told back in May that they do not do pre-authorizations for it either. Then they sent me a letter pre-authorizing my surgery date as well as the facility I was having it done at. I have Federal BCBS Basic. It's very confusing but they did authorize it and paid it in full no problems! Our insurance kicks butt! I got my approval in less than 4 business days.

[shadst83 0]

thanks ragdoll! I guess I'll just go for it and stop worrying so much. Do you remember what documentation your surgeon's office submitted with your claim?

BTW, you're doing GREAT! If I'm as successful in dropping the lbs as you have been, I guess all the drama will have been worth it.

[ragdollx19 1]

The only thing they submitted was my current weight/height and a few papers I filled out stating what weight loss attempts I had already made. No documentation of any other kind. If you are over a BMI of 40 thats all it takes.

Thanks for the compliment! I havent felt this good in a LONG time!

[Jhlopez 0]

I had to go through the 6 month documented physician supervised diet/nutrition visits. Even with it, BC/BS denied me. There is a lawyer out of California, Walter and Kelly Lindstrom-obesitylaw.com-They specialize in getting the insurance to cover surgery. It didn't cost me a penny. There is a program your doctor's office should be aware of that offers legal help freee of cost to the patient. The lapband manufacturer paid all my legal fees. I finally had my surgery last Wednesday. For the amount of time most of us have been overweight, a couple months fight with the insurance is nothing. Good luck

[elchewtoy 0]

I am worried about the bottom line. $$$$ I was told by the facility that I would have to pay my out pocket first, $5,000 the day of surgery. Once the surgery is done the paper work would be submitted to BC/BS Fed. At which time the facility would reimburse me if any thing was left? That doesn’t sound right to me. Did any one else have to do this?

E

[jbrad71629 2]

I had to pay $2300 out of pocket up front, I can't imagine ther would be a need for $5000 up front that seems excessive if they know it is going to be covered by your insurance.

[sallydee101 0]

I now have fbcbs standard.....tried in the past with atnea to be approved with 3 turn downs. I am trying again...BMI of 43

are there any requirements such as documenation of 6 months of diets ect?

[sallydee101 0]

I called the local doctor and found out bcbs fedral strandard is good about approval........was very encouraging.

I go to a seminar in a few weeks and they are scheduling first appointments in jan so not a bad wait.

So hoping, tried for 6 months in 2003 but had a clause that said no weight loss surgery with that company.

[tyme4change 1]

I have BCBS FEP Standard, I was told no preaproval was needed also, but it looks like you all have gotten it anyway. What do I need to do so I don't have a problem?