Anyone with BCBS FEP Experience?

[jdj 0]

I am just begining my process. Just finished the psych exam and was wondering if anyone has some experience with BCBS Federal Employee Program. Just wondering what they require and what time frame I can expect. Really want to get this done soon and I have a BMI over 41 and type 2 diabetes, high blood pressure, and high cholesterhol. Want to know how many hoops to jump through.

[Gregeriffic 0]

I am currently going thru the process w/BCBS FEP at the start of the process I had a bmi of 40 (which is lower now), I current have high blood pressure, high cholest, and severe sleep apnea (just diagosed 03/30/09). BCBS FEP will cover 70% of the surgery which means I'll pay the remainder which is 5000.00. It's been a very long process and at times I forgot about it completely but then I get an appt letter. I have no idea what the next step in the process is. my bmi and co-morbs alone should be enough. Havent been hassled by BCBS but this Hospital is giving me hell (Scott&White, Temple TX)

time line

6/11/2008 orientation

12/2/2008 initial appt plus finance (BCBS FEP approved)

12/4/2008 psych evaluation (passed)

01/16/2009 (cardio pulmonary exam/refer to sleep study)

03/30/2009 sleep study (sleep apnea confirmed)

04/03/2009: still waiting, no date as of yet, called bariatric coordination who said they are waiting on the sleep lab results.

honestley these appts are a nuisance

[bklyn1984 0]

I have standard option. My approval was received less than 48 hours after being submitted. I have not experienced any problems with this insurance. Go to Blue Cross and Blue Shield's Federal Employee Plan

and download the 2009 brochure plan. With a BMI of 40+ you are not required to do a 6 month diet. You will need to have diagnosting testing done (your surgeon should let you know what tests the surgeon requires) and a psychological exam.

I made sure everyone was in network so my out of pocket was very little. My time frame was over 7 months but not because of BCBS FEP. My surgeon's office required that I

do the 6 month diet and would not give me a date until I had everything done on their checklist and the insurance approved it. Make sure your surgeon's office is completely familiar with this insurance. They hear BCBS and they have it in their head that they all work the same and FEP is very different as you know. My surgeon required cardiac clearance, pulmonary clearance (I have asthma pretty bad), and my primary clearance. Then I had a Upper GI, Chest X-ray, and Blood work. They also sent me in for a sleep study and found that I have sleep apnea so that added time to everything too.

This is just my experience while it was not a very bad one I wish that I had been more aggressive with office when it came to the 6 month diet because it was not required.

Just make sure to read the brochure plan to know exactly what you can expect with things like deductibles, hospital stay if necessary, outpatient surgery (this changed), and what you will be responsible for if any of your providers are out of network they a few changes with that also.

[Petunia825 0]

I am just beginning my process too and was told by bcbs that I needed five years of weight loss history. What's up with that! I have done most of it with over the counter and local gyms.

[stickaforkinme 0]

I am just beginning my process too and was told by bcbs that I needed five years of weight loss history. What's up with that! I have done most of it with over the counter and local gyms.

Me too! I am wondering how this is going to complicate things. Any advice? (I have BCBS FEP Standard for insurance).

[stickaforkinme 0]

[snip]With a BMI of 40+ you are not required to do a 6 month diet.

My surgeon's office required that I do the 6 month diet and would not give me a date until I had everything done on their checklist and the insurance approved it...I wish that I had been more aggressive with office when it came to the 6 month diet because it was not required.

So are you saying that w/ BCBS FEP Standard, I technically shouldn't have to do a 6 month diet if I have a BMI of 40+ to satisfy the insurance requirements?

That would be really good news if its true.

[bklyn1984 0]

So are you saying that w/ BCBS FEP Standard, I technically shouldn't have to do a 6 month diet if I have a BMI of 40+ to satisfy the insurance requirements?

That would be really good news if its true.

Yes that's true I confirmed with them that there is no 6 month diet with a BMI of 40+. If you are below 40 BMI then they will look for the 6 month diet and documentation of previous attempts and your co-morbidities. If your surgeon's office insists that it is BCBS FEP then they do not know this insurance. It applies to both Standard and Basic Options. I am in NJ so my contact is BCBS NJ. I was told by someone at BCBS that your surgeon should know what to include in the package that is sent to them. My surgeon's office put me through everything and if I did not like my surgeon the way I do I would have went to someone else. But I like him and I trust him. I had to give notes for 5 years and do a 6 month diet. So it was my surgeon's office who required this not BCBS FEP and I have read that I am not the only one who has had this problem.

You still have to go through the diagnostic and psychological testing that you cannot get out of. It will also help if you do have co-morbidities. When my surgeon found out I had sleep apnea he was concerned for my health and at the same time he was happy since he said that this is one of the top co-morbidities for WLS approval.

Here's what it is in the plan brochure that's available at Blue Cross and Blue Shield's Federal Employee Plan:

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.

Note:

You must get prior approval for outpatient

surgery for morbid obesity.

Please refer to page

16 for more information.

If I were you I would call your BCBS and confirm it with them and get their name. I do not think it's a state by state plan but check your plan brochure to make sure.

Edited April 7, 2009 by bklyn1984

[bklyn1984 0]

I am just beginning my process too and was told by bcbs that I needed five years of weight loss history. What's up with that! I have done most of it with over the counter and local gyms.

Is your BMI below 40? If not, then call them back and speak to a supervisor I was told no diet and no documention other than the diagnostic testing results and psychological exam results.

[TiffanyPink 0]

Hi everyone. This is my first post here. I have finally decided that this is the tool that I need to change my life. I have BCBS Federal Basic and I just had my Psych eval today. My surgeon (or maybe BCBS) requires 2 years of medical records. No problem there. Finally, I have a 5 hour nutrition class on Sunday. After I've finished the class, I will have done all my requirements and they say they will submit to BCBS. So, hopefully, it won't take too long before I'm approved. Now that I've decided this is what I want--NEED to do, I'm so antsy and ready to get this started! Good luck to all!!

[Gregeriffic 0]

Still waiting, called Bariatric dept. at Scoot & Wait several times, and only get as far as the patient advocate (who attempts to retrieve my information or transfer me to the Nurse Prac to no avail). One day they'll return my calls. Maybe this is a warning not to have the surgery?

...starts to seek out "Lapband Gone Wrong" post

Not stopping.

6/11/2008 orientation

12/2/2008 initial appt plus finance (BCBS FEP approved)

12/4/2008 psych evaluation (passed)

01/16/2009 (cardio-pulmonary exam/refer to sleep study)

03/30/2009 sleep study (severe sleep apnea confirmed)

04/03/2009: still waiting, no date as of yet, called bariatric coordination who said they are waiting on the sleep lab results.

[Pinki_290@Yahoo.com 0]

I have federal bc/bs. I was banded August 2008. When I called the insurance told me they paid like any other surgery. I paid co-pay for all the pre test and doctors and ended up paying the doctor $150.00 and the hospital $1800.00 out of pocket. There were a few smaller bills for antheoligist(?). The only thing that concerned me, was that the hospital charged $23,000.00. I was only there 6 hours from start to finish. The $1,800 was my 15 percent after the insurance pays it's 85percent

[Gregeriffic 0]

Well just completed my lapband lifestyle class, nothing else left but to sit and wait.

6/11/2008 orientation

12/2/2008 initial appt plus finance (BCBS FEP approved)

12/4/2008 psych evaluation (passed)

01/16/2009 (cardio pulmonary exam/refer to sleep study)

03/30/2009 sleep study (sleep apnea confirmed)

04/03/2009: still waiting, no date as of yet, called bariatric coordination who said they are waiting on the sleep lab results.

04/20/2009 Required Lifestyle class down (all boxes checked)

Edited April 22, 2009 by Gregeriffic

[Lisa07 0]

Do you know if Care First Blue Choice FED is the same or equivilant to BCBS? I'm over a 40 BMI but they told me today that I needed the six month diet plan or two three month consecutively. I have 3 months on NutriSystem but it all has to be in a 2 year time period so I need another 3 months...that would be great if I could get that waved.

[NewSexyMe 1]

ok....so I have bcbs federal Basic plan....

I live in TX (need to find a DR. in south Texas)

My ? is:

Why if it says it covers 100% did you all have to pay from $1200-$5000???

I thought it would only be a Copay of $100 for each in network providers and hospital stay....

I have a bmi of 37 I am 5'8 245lbs

I have athsma (REALLY BAD!)

maybe high cholesteral....(its kinda high, but I dont take meds for it):thumbup:

The thing is that....

I HOPE IT WONT be a problem to get approved and that I DONT have to wait half a year since I am below 40 bmi,:wub:

I have only had insurance for like 2 yrs. of the past 5 yrs. (struggling times) so I dont have any type of documentation of my weight....

and diets have been like GNC stuff and just @ home excersise....

(I never really went to a Gym since I am SO FAT, its not a very comfortable place to be at...... You know what I mean??)

anyhow......

Does anyone have any idea on how that would work???:wub:

[whitwolf81 0]

I have the basic option and I started the process in December and had visit to a dietician to monitor my weight and diet class. I also had the physc exam. I am schedualed to see the surgen on June 15, to schedual my surgery date.

I think it also varies with the surgon you go to.