Federal blue cross blue sheild

[3m'smom 0]

Has anyone else used federal bcbs? I have heard it pays well, What were out of pocket costs and the procedures for approval? Any info would be appreciated, I go to seminar on April 29th in Jonesboro, Ar and would love to know some things before I go.

[pennyt 14]

I've got the basic option of BC/BC, and it took less than three weeks for approval once the doctor's office sent everything in to them. There was no requirement for a 6 month supervised diet. I did need to have a BMI over 40 (which I had to gain to get), or else co-morbidities.

When I went in for my seminar and surgical consult, the person running the seminar said that FEP BC is the easiest to get approved.

I had to have a psych eval, which only cost $20 for the co-pay. You'll need to call BC to get the name of a provider for the psych eval so that they pay. When I phoned, I told the customer service rep why I was going, and she approved 16 visits right then and there, in case I wanted to continue to go if any issues were found during the evaluation.

From my experience with FEP BC, surgeries have a $100 co-pay, as well as a $100 copay for the facility. I'm concerned that there might be a difference in how the actual band is covered under in-patient and out-patient surgery. I plan to call BC to ask on Monday.

[3m'smom 0]

Pennyt, please let me know what you find out when you call on Monday. Good luck.

[JRFAN88 1]

We have several things in common - I also live in Arkansas & I'm also 39 years old & I also have federal bc/bs. I went for my first appointment about a month ago with the surgeon. The following week I did the sleep study & psyche eval. I got my call this Thursday to schedule my surgery. I couldn't believe it. My BMI was 40. I also found I had 2 co-morbidities that I didn't even know I had. Well one I sorta knew about. I had some high blood pressure troubles last year when I went through a rough divorce after 17 years of marriage. The doc just assumed that was why & never put me on meds for it. But when I saw the surgeon she told me I needed to go back to my family doc to get on bp meds because it was too high. I also found out during the sleep study that I have sleep apnea & I would've never guessed that. I go Monday to get fitted for my c-pap machine. I'm not sure if that helped me get the insurance to pay for the surgery but it probably didn't hurt. With our insurance I was told that we had to have 5 years of medical records. I was worried about that because I have always been a yo-yoer. One year my weight is only 30-40 pounds overweight & the next year I'd be 80 pounds overweight. I also had to show evidence of trying to lose weight for at least 6 months. I was worried about this because I didn't have any medically-supervised programs. I showed journals of different plans I had done on my own & they made copies of these to send to the insurance companies. She told me our insurance does not say that they have to be medical-supervised. I am still in shock about all this but really can't wait to get started with my new life. My 40th bday is in October & I want to have my weight issues under control for the last time by then. Good luck with everything!

[88KEYZ 0]

My BC/BS would not cover me at all...the policy states they pay for 2 nutrition classes per year and nothing else toward weight loss. Therefore, next Saturday the 19th, I'm fly to Tijuana, Mexico and surgery is set for that afternoon after my pre-tests. :sneaky: I am excited, but right now on the liver shrinking diet of 40 - 50 carbs (max per day) and high Protein, calories do not matter. So far - so good!

[Rocket City Guy 0]

[quote name=

From my experience with FEP BC, surgeries have a $100 co-pay, as well as a $100 copay for the facility. I'm concerned that there might be a difference in how the actual band is covered under in-patient and out-patient surgery. I plan to call BC to ask on Monday.[/quote]

Pennyt,

Please post what you find out. I have Fed BC/BS, basic option, and had my band placed back in Feb. I had a $100 copay for the surgeon, and a $40 copay for the hospital, but like you mention above there is a HUGE difference in how the band was covered for my outpatient surgery (70%) vs. how it would have been covered if my surgery had been inpatient (100%). It ended up being almost $1600 copay just for the band!

If anyone reading this has fed bcbs basic option and had their surgery done outpatient, please post and let me know how your band was covered, if it was different than I described above.

Thanks!

[pennyt 14]

I called FEP BC Customer Service, and was told that if the surgery is done as out-patient, there is a $100 charge for the surgeon, and a $40 copay for the facility. We would also have to pay 30% of the billed cost of the actual lapband device. That could end up being hundreds and hundreds of dollars.

If the surgery is inpatient, which means staying 24 hours plus at least a little longer, there is the $100 copay for the surgeon, a $100 copay for the facility per day (up to $500 total for 5 or more days), and NO extra costs for the actual device.

I just called my surgeon's office, and Misty is going to look into this further. SHe said if need be, I will be in-patient.

[flowergurl 0]

Hi, I just wanted to pop in & give you my experience. I have Federal BCBS, live in Arkansas and just had the Lap Band surgery on 3/5/08. I'm still watching my claims to see if & how they are getting paid. So far, everything has been covered...I'm waiting for the hospital bill to get paid. I've not had to make ONE phone call to BCBS. You all really need to know your policy--it seems like we may have slightly different policies and/or being told something different with each phone call. This can & does happen...I worked in customer service for a major health insurance company at one time. Anyway, my plan has a $300 ind ded or $600 fam ded. After ded is met, my plan pays 90%. My in-patient hospital co-pay was $100. I had to meet my deds on the surgeon's bill and labwork plus my 10% coinsurance. So far, I've been out of pocket roughly $500. Not too bad considering this surgery is thousands of dollars. My BMI was 46 with no co-morbidities. My literature states that a BMI >40 is considered eligible for WLS. BMI <40 are only eligible if co-morbidites exist. I have also heard, as someone else stated, that our insurance is one of the easiest to pay; however a year ago & a different surgeon than the one I had, refused my insurance b/c "they wouldn't pay up". So I don't know who's right or wrong here...but I've not had any problems thus far. Trying to cover all the questions...not sure if there is anything else I should mention...except that the only pre-op stuff required was by my surgeon which included a dietician/nutrition counsel session (by conference call), support group meeting, labwork & a 2 week pre-op Protein shake diet. The diet, do not mistaken, was not for liver shrinking but to measure dedication...if I did not lose weight, the surgery would have been cancelled. Period. If anyone has any specific questions, please PM me. I am still trudging through claims but I do not anticipate any problems. GOOD LUCK to all of you pre-op!

I wanted to add also that I was not able to get an approval number...I felt really uneasy about it...but so far, no issues. Supposedly, BCBS federal will not pre-auth WLS...however I did get my hospital stay pre-certed...???

Edited April 18, 2008 by flowergurl
to add info

[Rocket City Guy 0]

Flowergurl,

I really think FEP BCBS benefits are the same nationwide, taking into consideration whether one has the basic option or standard option. I think where some of the differences some of us have experienced are due to the way hosp and dr's bill for the operation. You mention your copays after deductible for the doctor and for the hospital, but do you know if you will be billed for the band itself? I myself was, and since the hospital billed it instead of the doctor, I was responsible for an additional copay of 30% of the allowable charge, as the band system is considered durable medical equipment...if my surgery had been inpatient instead of outpatient, I wouldnt have been responsible for any additional costs for the band.

Going from what your post said, it sounds like you have standard option bcbs, so if you are billed for the band system by the hospital instead of doctor, you will have to pay 10% of allowable for that.

So I guess I'm just trying to say its not just that we need to read our plan brochures (which we do!)...there are many different factors that can affect how our benefits are applied

[flowergurl 0]

Rocket City Guy, it was not my intent to imply that we do not read our brochures. Our brochures do not give specific information, especially about WLS. My brochure did not mention requirements for WLS other than the BMI references. I also thought FED BCBS was the same nationwide but from what I've read, many people are paying differently. Interesting info on the band vs DME. Guess that is something that I will look for on my claims as I have no idea how or who billed for the band.

[psa 0]

I have Fed BCBS Basic in Indiana, and recently was denied coverage for a vertical sleeve gastrectomy. They claim "At this time there is insufficient convincing evidence in the peer-reviewed medical literature, in terms of safety, to support the use of sleeve gastrectomy in individuals with clinically severe obesity". I personally know two people that have had this procedure, and were covered by BCBS FEP. I am sending them an appeal letter to them to start with. Does anyone have any suggestions?

Thanks,

Pam