Anyone Have Federal BCBS?

[sleeveme7781 33]

I am about to start a new job working for the department of defense and was wondering if there are any federal employees out there who can 1. point me in the direction of the best plan to select that will cover the sleeve surgery, and 2. what are the requirements? I am trying to get a timeline of how long it will take from initial visit to surgery date, so I can plan accordingly. I will be teaching on a base, so I was hoping to be able to have my surgery no later than the last week of March (spring break) so I could recover for a week and be back to work without missing any days. How likely is that, if my first visit isn't until January?

Should I start the process of meeting with a NUT now? Will it count?

[Cynrey 16]

2 minutes ago, sleeveme7781 said:

I am about to start a new job working for the department of defense and was wondering if there are any federal employees out there who can 1. point me in the direction of the best plan to select that will cover the sleeve surgery, and 2. what are the requirements? I am trying to get a timeline of how long it will take from initial visit to surgery date, so I can plan accordingly. I will be teaching on a base, so I was hoping to be able to have my surgery no later than the last week of March (spring break) so I could recover for a week and be back to work without missing any days. How likely is that, if my first visit isn't until January?

Should I start the process of meeting with a NUT now? Will it count?

I have Fed BCBS basic. I just got approved and am having my surgery on Wednesday. Their requirements are a BMI of at least 35 or above. If your BMI is over 35 but under 40, then you must have at least 2 comorbities such as high blood pressure, high cholesterol, diabetes, sleep apnea. 40 and above BMI doesn't require any comorbitiy. They require 3 months (in a row) of a supervised diet plan with your physician , a referral and letter of medical neccessity from your physician and a history of obesity. Because of the required 3 month supervised diet it takes at least that long for approval. My gastric surgeon's practice is the one who required the NUT, Physc eval, and a few classes. It sounds daunting, but it wasn't that bad. I started in July and good approved in November. Mine took that long because of the 3 months consecutive appointments that were needed with my doc. Good luck to you !

[sleeveme7781 33]

11 minutes ago, Cynrey said:

I have Fed BCBS basic. I just got approved and am having my surgery on Wednesday. Their requirements are a BMI of at least 35 or above. If your BMI is over 35 but under 40, then you must have at least 2 comorbities such as high blood pressure, high cholesterol, diabetes, sleep apnea. 40 and above BMI doesn't require any comorbitiy. They require 3 months (in a row) of a supervised diet plan with your physician , a referral and letter of medical neccessity from your physician and a history of obesity. Because of the required 3 month supervised diet it takes at least that long for approval. My gastric surgeon's practice is the one who required the NUT, Physc eval, and a few classes. It sounds daunting, but it wasn't that bad. I started in July and good approved in November. Mine took that long because of the 3 months consecutive appointments that were needed with my doc. Good luck to you !

Thank you so much! That doesn't sound so bad, actually. I will most likely shoot for a summer surgery then. That way, I can recover in peace and not stress with having to go back to work. I was also wondering, how much were your out-of-pocket expenses?

and one more thing, if you are at 41 BMI with no comorbidities, and then lose weight during the supervised diet (I can always loose weight. It's keeping it off that's the problem), will that disqualify me? Does the physician / surgeon go with your initial weight or the weight at the time of surgery?

[Cynrey 16]

3 minutes ago, sleeveme7781 said:

Thank you so much! That doesn't sound so bad, actually. I will most likely shoot for a summer surgery then. That way, I can recover in peace and not stress with having to go back to work. I was also wondering, how much were your out-of-pocket expenses?

and one more thing, if you are at 41 BMI with no comorbidities, and then lose weight during the supervised diet (I can always loose weight. It's keeping it off that's the problem), will that disqualify me? Does the physician / surgeon go with your initial weight or the weight at the time of surgery?

I'm not sure about being disqualified for losing weight during the diet. I only lost a couple of pounds during mine because I wasn't sure either. My weigh ins during the 3 months were fairly consistent, within a few pounds.

I understand about the losing/ regaining..... I've always had that problem too. Frustrating! I lost 50 pounds a few years ago and gained it all back, plus 30. Ugh

My out of pocket was co pays for all PCP visits ($30 each) co pays for the surgeons visits ($40 each, only 2 of those) $175 for the NUT one on one consult, $200 for surgeon fee (for performing the surgery) , co pay for the physc ($25), co pay for pre op ($40), $175 for 1 night in hospital. I had to see a cardiologist once because of my age, ($40) The NUT classes were free. So, about $825

hope this helps

[sleeveme7781 33]

1 minute ago, Cynrey said:

I'm not sure about being disqualified for losing weight during the diet. I only lost a couple of pounds during mine because I wasn't sure either. My weigh ins during the 3 months were fairly consistent, within a few pounds.

I understand about the losing/ regaining..... I've always had that problem too. Frustrating! I lost 50 pounds a few years ago and gained it all back, plus 30. Ugh

My out of pocket was co pays for all PCP visits ($30 each) co pays for the surgeons visits ($40 each, only 2 of those) $175 for the NUT one on one consult, $200 for surgeon fee (for performing the surgery) , co pay for the physc ($25), co pay for pre op ($40), $175 for 1 night in hospital. I had to see a cardiologist once because of my age, ($40) The NUT classes were free. So, about $825

hope this helps

Oh wow! Well, I am going from a plan that doesn't cover it at all to a plan that does. I was initially considering having the surgery here and be self pay (for $12,000) and then I decided to go to Mexico ( for $5,500)... so this is definitely the best of both worlds! Getting the surgery domestically, where I will have the proper follow-up, and paying less that $1,000 is definitely a much better deal. The only thing that stinks is that I would get the surgery TOMORROW if I could! Once I decided that I was going to do this, I became so impatient! Thank you so much for all of your advice! You have been a great help!

Have you already gotten the surgery? You mentioned you were approved in November. How long before you can actually have the surgery? If you have had it already, how has your experience been?

[Cynrey 16]

58 minutes ago, sleeveme7781 said:

Oh wow! Well, I am going from a plan that doesn't cover it at all to a plan that does. I was initially considering having the surgery here and be self pay (for $12,000) and then I decided to go to Mexico ( for $5,500)... so this is definitely the best of both worlds! Getting the surgery domestically, where I will have the proper follow-up, and paying less that $1,000 is definitely a much better deal. The only thing that stinks is that I would get the surgery TOMORROW if I could! Once I decided that I was going to do this, I became so impatient! Thank you so much for all of your advice! You have been a great help!

Have you already gotten the surgery? You mentioned you were approved in November. How long before you can actually have the surgery? If you have had it already, how has your experience been?

I’m glad I could help.

BCBS has been great! One you have everything done and it is submitted , they approved me in less than a week.

I am having my surgery on this Wednesday, Dec 6th. Started my clear liquid diet today. So nervous!

[sleeveme7781 33]

18 minutes ago, Cynrey said:

I’m glad I could help.

BCBS has been great! One you have everything done and it is submitted , they approved me in less than a week.

I am having my surgery on this Wednesday, Dec 6th. Started my clear liquid diet today. So nervous!

OMGness!! That is so exciting!! I think it's normal to be nervous. I am sure you will do great! How long have you been on a pre-op diet? Is it for 2 full weeks? how insane is it? Gosh, I wish I was in your shoes!! You got this Cynrey!

[Cynrey 16]

1 hour ago, sleeveme7781 said:

OMGness!! That is so exciting!! I think it's normal to be nervous. I am sure you will do great! How long have you been on a pre-op diet? Is it for 2 full weeks? how insane is it? Gosh, I wish I was in your shoes!! You got this Cynrey!

Thanks so much!!! I’m lucky in that my surgeon only requires 2 days of Clear Liquids and a clear Protein Drink each of those 2 days. Spent this past weekend having “food funerals “. LOL. After surgery I’ll post when I’m able

[sleeveme7781 33]

34 minutes ago, Cynrey said:

Thanks so much!!! I’m lucky in that my surgeon only requires 2 days of Clear Liquids and a clear Protein Drink each of those 2 days. Spent this past weekend having “food funerals “. LOL. After surgery I’ll post when I’m able

That is pretty lucky! I have heard of grueling all liquid diets for two whole weeks pre-op. "Funeral foods" is hilarious!! I used to call those meal my "last supper" meals right before a diet. Keep me posted about what happens! I want to offer you encouragement if you need someone to talk to! Gosh I'm so excited for you!

[Cynrey 16]

16 minutes ago, sleeveme7781 said:

That is pretty lucky! I have heard of grueling all liquid diets for two whole weeks pre-op. "Funeral foods" is hilarious!! I used to call those meal my "last supper" meals right before a diet. Keep me posted about what happens! I want to offer you encouragement if you need someone to talk to! Gosh I'm so excited for you!

Thank you sleeveme!

[atghr10 1]

I’m glad I could help.
BCBS has been great! One you have everything done and it is submitted , they approved me in less than a week.
I am having my surgery on this Wednesday, Dec 6th. Started my clear liquid diet today. So nervous!

It has been 2 weeks
For me tomorrow!!! Still no answer from my insurance. BC/BS Federal. [emoji31]

[Cynrey 16]

1 hour ago, atghr10 said:

It has been 2 weeks
For me tomorrow!!! Still no answer from my insurance. BC/BS Federal.

I called them when it was one week. They told me it had been approved that day. If you call them you may find out before your surgeon is notified.