Federal BCBS

[edna 0]

Guys

I am having a time with the staff in my Dr. office. They keep telling me that federal BCBS has changed its requirement and now require patients to wait six months after consultation, eval, labs and all the other before you are able to have surgery. I want to know if anyone else is having that problem. I had hoped to have my surgery before the year was out, but now I am getting different answers from the Dr. office and federal BCBS and sort of changing my mind about the surgery. If anyone else is having the same problem, please let me know.

Georgia Peach

[jbrad71629 2]

Edna

I just had my surgery last week and I have Federal BCBS of GA there was no waiting period at all. If i were you I would call the BCBS rep direct and talk with them. They are not allowed to make that kind of change in the middle of a benefit year and not give any kind of notice to the policy holders. It sounds like your surgeons office is mistaken, and maybe that could be a change that is coming up in January... best of luck !

[MollyBrown 0]

Edna,

I agree with Jeannie. I got the procedure code(s) from the surgeons office and called BCBS Federal directly. The person I spoke with said, that although I could not consider this an official "pre-authorization", that because I am (was) 100lbs overweight, with co-morbities, I would be approved for the surgery AND I was not subject to a six month supervised diet or a psych eval.

My doctor's office still required the psych eval, but not the six moth supervised diet.

There are just so many insurances, your Dr.'s office must be mistaken because Jeannie is exactly right, they cannot change their policy within the year to a more restrictive requirement without sending out some type of official notice.

Fight it, be your own advocate and make it happen... After all, it is the benefits that make us stay working for the Feds, Lord knows it isn't for the pay...

[tyme4change 1]

I had my consultation on the 31st of January and I have not gotten a phone call yet for my surgery date. :tt2: I have Anthem BCBS Fep which does not require prior approval, so what's taking so long for a date? Can anyone shed some light on the subject? :mad:

[pennyt 14]

I had an appt at the St. Francis (IN) Bariatric Center last week, and have the all day seminar next week where I'll speak to a dietician, an internal med doctor, meet the surgeon, and find out all about the surgery.

I'm at 39.6 BMI, so I've decided try to gain 4 pounds before the seminar on Monday, so that I'll be right at a 40 BMI.

For those of you with Federal Employee Blue Cross Basic Option, how hard was it to get approved? How long was the approval process? What was required for approval?

Any info is much appreciated! I'd love to be able to have surgery on spring break in March since I was already planning on being off work.

[ragdollx19 1]

Kara- Call your doctors office and ask them! Call them every day if you have to until you get an answer. You have the right to know what the next steps are and when they will happen.

penny- I have Basic BCBS Fed and they submitted a written medical history I provided them stating what all weight loss attempts I had made, along with my current height & weight. They sent my info off on a Thursday and by Monday or Tuesday I called to verify they got the paperwork and I was approved. I had surgery almost a exactly a month from my initial phone call for a consultation.

Fed BCBS paid just as they said they would. PM me if you have more specific questions and GOOD LUCK!

[ronwifey 0]

I have BC/BS FED Basic and the office manager at the surgery center told me that BCBS FEP has a "special department" now that handles nothing but Weight Loss Surgery. As soon as my Dr.s office got the OK from my psych eval they called BCBS up and got approval right then and there. The office manager told me that BCBS FEP is one of the easiest to get approval for IF you meet 40 BMI. They don't require a 6 month diet or anything like that. I went to my seminar like 3 weeks ago, had 1st appointment with Dr., dietician and psych eval about 2 weeks ago and got the call from Dr's office with surgery date yesterday.

[Ms Mississippi 0]

I work for the Federal Govt and it didn't take no time for me to get an approval the office staff said that my Federal BCBS had a contract with them and would pay if it was necessary but it took me about 1 day and I was on the OR table well good luck and I hope everything works out for you and such a lovely baby.

[tyme4change 1]

Well I took your advise and called to see what was going on. My insurance is a go and they said I should something back next week. So I am one more step closer.

[RandiW 0]

From my initial phone call to my surgeon it was almost exactly a month to surgery date. My paper work was submitted on a Thursday and I had been approved by Monday or Tuesday. BCBS Federal paid all of my bills as promised. Our insurance rocks!!!

I have TX Federal BCBS...I am trying to find out Exactly what I have to have to qualify through insurance. Doctor is NOT helping at all. Would like to know what you did. THanks!

Forexample...regular BCBS requries 6 months diet history, when I called my federal plan, they said this was not a requirement, though the doctor tells me it is. It seems they don't want to call MY insurance plan and discuss it and treat me like a regular BCBS patient. Help!

Oh...I have a BMI of 36...I have PCOS (Poly Cystic Ovary Syndrome), high cholesterol, undiagnosed arthritis, sever back pain, thyroid disease.

When I called my plan they told me they defined a co-morbidity as "anything that causes weight gain". As opposed to things that are caused by weuight gain. Sounded backwards to me. Either way, I think I will qualify. PCOS and Thyroid cause weight gain. Others are a result of weight gain. Other than co-morbidities, trying to find out what others had to submit to be approved.

Thanks!

Edited September 19, 2008 by RandiW
Left something out!

[bklyn1984 0]

I have TX Federal BCBS...I am trying to find out Exactly what I have to have to qualify through insurance. Doctor is NOT helping at all. Would like to know what you did. THanks!

Forexample...regular BCBS requries 6 months diet history, when I called my federal plan, they said this was not a requirement, though the doctor tells me it is. It seems they don't want to call MY insurance plan and discuss it and treat me like a regular BCBS patient. Help!

Oh...I have a BMI of 36...I have PCOS (Poly Cystic Ovary Syndrome), high cholesterol, undiagnosed arthritis, sever back pain, thyroid disease.

When I called my plan they told me they defined a co-morbidity as "anything that causes weight gain". As opposed to things that are caused by weuight gain. Sounded backwards to me. Either way, I think I will qualify. PCOS and Thyroid cause weight gain. Others are a result of weight gain. Other than co-morbidities, trying to find out what others had to submit to be approved.

Thanks!

I have BCBS Federal NJ - Here's what it says in my benefit handbook:

Gastric restrictive procedures, gastric malabsorptive

procedures, and combination restrictive and

malabsorptive procedures to treat morbid obesity –

a condition in which an individual has a Body Mass

Index (BMI) of 40 or more, or an individual with a

BMI of 35 or more with co-morbidities who has

failed conservative treatment; eligible members

must be age 18 or over. Benefits are also available

for diagnostic studies and a psychological

examination performed prior to the procedure to

determine if the patient is a candidate for the

procedure.

I would check your benefit handbook too. If it says what mine says than you need to find out what they mean by failed conservative treatment. I am going through the same thing with my surgeon's office. My BMI is over 40 and I was told by the insurance company that I did not require anything but the psychological exam. The surgeon's office will not give me a surgery date or submit to my insurance until I have completed all of their requirements. I pointed out to them what the insurance company said and what the benefits handbook said and they insist it's an insurance requirement. They will not listen. I only have my sleep apnea portion to complete and once the sleep doctor sends her amended letter and gives me clearance that's when I am supposed to get a date and info sent to insurance.

[LoriLei 0]

I am in Iowa. I have BCBS Federal and it was about 2 weeks from the time I filed until I was approved. I do not have a surgery date yet but am looking forward to the day.