BCBS Federal Employees Plan (FEP) Stalling After Surgery

[Linda Hamsing Rosen 1]

Hi,

Has anyone encountered this situation: My doctor's office called me in december 2007 (before my surgery) stating that I was pre-approved (they had written to the insurance company). Then I had the surgery in February 2008 and the insurance company took forever to respond and then once they did, they said they needed more information. I called to find out what and they said "medical records." I called the Dr.'s office and they said that Blue Cross Blue Shield Federal Employees Plan doesn't really "pre-approve" and they never go an actual "pre-approval" just a letter stating that the procedure was covered. I already knew that ! I just about freaked out. The doctors office sent them my "physical" and pre-operative assessment. Now I'm wondering if the insurance is going to pay. I had a BMI of 38 with high cholesterol and a fatty liver. Are these considered official "co-morbidities?" Do you think the insurance will pay? Is this a stall tactic?

[snowbird 2]

Yes, those are valid co-morbidities. I would call back BCBS and ask them more specifically what they need. Ask to speak to a supervisor or someone with more authority if you do not get an adequate reply. Ask them if they have requested the needed information from your doctor, and then ask them what your doctor's response has been. Get dates of their contacts with your doctor, and write down names and phone numbers of people you contact at BCBS. Believe me, it can be a pain, but if you show them you are thorough and not going to be put off, I bet they will come through. I have experience from a couple of sides with this stuff: first, I worked for the Social Security Administration processing claims for 25 years, and secondly, I have dealt with BCBS myself. Keep pushing, but keep it polite and calm, and I think you will see things moving along. Unfortunately, it is the nature of some people to give a glib answer and consider the problem solved if you go away and don't bother them anymore. Don't let that be a resolution for them.

[Onnie67 0]

Make sure you list ALL your co-morbities..

anything you have...it helps. My doctor put down mild hypertention, GERD, back and joint pain, restless sleep, planter fasica, heavy periods...anything and everything...

[Linda Hamsing Rosen 1]

Thanks for the advice. After calling the doctors office and finding out that they did respond, I called the insurance and asked them if they got everything they needed and they said they did. BCBS then said they would assign it right away and have it "rushed." So it looks like it did help to call. Now I have to do the same thing with the hospital.

[snowbird 2]

Good to hear things seem to be moving along. I would advise you make a note of the dates you talked to them most recently, and follow up in a couple of weeks if you haven't heard anything further. Unfortunately, the squeaky wheel does get the grease in the insurance business!

[JRFAN88 1]

Do you mind me asking what your copay was with Federal BC/BS? I am scheduled for surgery next Wednesday. I thought I had read on this site where most people on this insurance had about $100 copay. I just received a call from the surgery center to tell me about my copay there - $923.41 which is 15%. Now I'm worried about what the surgeon's bill will be. Don't get me wrong - I'd have probably paid it myself (with payments of course) but this was quite a shock.

[snowbird 2]

My husband and I were banded in Mexico. BCBS/FEP reiumbursed him $7900 of the $8000 total cost of the procedure, and they reimbursed me $7200. Don't know why the amounts were different, other than two different claims adjusters worked on them.

[thenewkatio 0]

I had surgery at Texarkana Surgery Center in July 2008. I was told my copay was $40, but when I arrived the morning of the procedure, they told me I would have to pay $1240 for the band itself! I had to make a $400 downpayment that day and then pay the rest by automatic withdrawal each month. When I first called BCBS they said the band should have been covered, and that the hospital should not require prepayment of anyting other than copay. I contacted the surgery center and they denied knowing that. When I called BCBS back I was told that the band WAS NOT covered! I am still trying to get this straightened out, in addition to another surgery in September 2008 and they want to do another one but I can't afford the $900 that Wadley Hospital is requiring up front!