BCBS FEP: Psychological evaluation prior to approval?

[Linda Hamsing Rosen 1]

Hi,

I have the Blue Cross/Blue Shield Federal Employees Plan. The center I am going with submitted all my paperwork documenting my BMI (38) and health history (high cholesterol) for insurance approval. After 4 weeks, the insurance wrote back and didn't approve or disapprove but asked for a psychological evaluation to be submitted. Why would they do this? Is this a good sign that once I "pass" this, they will approve? Has anyone else had this situation? What are they looking for exactly? Thanks so much ! I'm excited but scared

[Tuono_John 0]

I work for a surgery center that does just lap bands. The psyche study is a standard part of the possible approval process. The will probably ask for a Nutritional consultation. These are just standard parts of the process. If you want to PM me, I can fill you in more.

John

[Poopsie 1]

Hello Linda,

I have Federal BCBS also. I am just beginning my journey. I have to see a psychologist and a nutritionist. A friend of mine that has the same insurance was banded about 2 weeks ago, had to do them same in addition to a sleep study. In your benefits book, under gastric surgery, it mentions something about benefits are available for psychological exam to make sure of the surgery. I'm sure after that, it's approved.

[snowbird 2]

My husband and I have FEP BCBS. We went to a psychologist for a pre op evaluation. Just a warning: I asked for a copy of a report to submit to BCBS, and he charged us $390 each for the report, which was not covered by insurance. So talk to the psychologist to see what unanticipated charges you might incur with him.

I just submitted the claim to BCBS two weeks ago and haven't heard anything yet. We had our surgery in Mexico, so we submitted our claimes as an overseas claim submitted after the surgery.

[Ellisa 6]

Snowbird,

How does that work? You pay upfront and then wait to be reimbursed? What are your chances they will pay after the fact?

Ellisa

[snowbird 2]

Yeah, that's what we are hoping. I talked to BCBS before we scheduled the surgery, and they told me they needed a referral from my PCP, a psych evaluation, and then the forms I could find online. On Dr Ortiz's forum there were a couple of others who had FEP BCBS and they received their reimbursement, so I'm hoping they will come through. My only concern is that they require a BMI of 35 or higher with co-morbidities which my PCP tried to document in his referral report. My BMI was right at 35 when I saw my doctor in August, but due to my pre op diet had dropped by the time I had the surgery. So we'll see what happens.

[elchewtoy 0]

Blue Cross Blue Shield/ FEP….. I am so confused! I was told that the surgery is covered; but BC/BS FEP will not approve the paper work till after the surgery is done?????? Can some one shed light on this?

E

[snowbird 2]

<p>Have you looked at the Bariatric Directory on the fepblue.com site? I haven't checked it out since I already had my surgery in Mexico, but I'm wondering if you use one of their bariatric providers if they will just cover the surgery as they would any other medical treatment. Anyone had any experience? What about fills-does BCBS cover anything there?</p>

http://64.14.1.170/bcbsa_new/(jvi21145ge20ifeyxqgf43yi)/main/BarDir.aspx?bar=yes&prefix=FEP&productType=SOO&link=GPD-BNI-501455

[elchewtoy 0]

I was told fills are covered as a visit, copay is what is needed.

E

[kansascase 0]

I also have Blue Cross/Shield insurance for Federal Employees. The doctor's office submitted the request for necessary medical treatment. It took all of three days before I was approved. Of course, that was after I was saw a psychologist, dietician, preop, etc. I even had to attend a support group. From the time I went to the seminar on lapbands until I had the surgery was almost 6 months and my documentation was extensive. I suspect you will have a good chance of getting approved after you see the psychologist. Of course, you BMI is kind of low - just my opinion. I can, however understand why you would want to take this step - to prevent additional problems and make dieting easier.