BCBS Federal Standard in the DC area?

Baires · June 5, 2008

Hi, I would appreciate hearing from people who had banding surgery in the DC area, who are BCBS Federal Plan Standard Option members. Any and all information you can give me will be useful. Stuff like: what was your BMI before surgery, did you have any comorbidities, what was the approval process like, did they require the 6-month supervised weight loss program, who did you choose for your surgery, was it in-network, how much did you end up paying out of pocket, would you recommend your doctor, etc. I have a BMI of 35-36, have several comorbidities including sleep apnea, high cholesterol, depression, etc, and I'm looking into the surgery. I went to a seminar but it turned out the doctor was out-of-network, so I can probably do better going in-network. Thank you in advance for sharing your experience.

trinity2008 · June 6, 2008

Hello,

I had the band done 4 weeks ago. We also have BCBS FEP Standard. FEP has a distinction center for weightloss surgery in Fair Oaks (Inova Fair Oaks Hospital). They are in-network and will ease the cost of the surgery. My upper GI and Fluro (spelling??) only cost me 5.00, which was nice. I have not received my EOB for the hospital or for the docs yet. So I am not sure how much I am responsible for, yet. But its nice because I will be billed. You will have to pay a 100.00 hospital stay fee prior to admission.

Distinction Center - In-network docs - two of them - are located at the Virginia Weightloss Surgery Center in Vienna, VA. See hyperlink to see surgeons. INOVA HEALTH SYSTEM : BARIATRICS : Meet Our Physicians

If you look in your 2008 benefits, or online, it shows you that Fair Oaks is their distinction center.

My doctors were Dr. Tran (who performed actual surgery) and Dr. Halmi - both are fantastic doctors! I have not had any problems with my band yet and many many patients have been very satisfied with them.

I was required to pay the nutritionist fee and the fee for the fills - total about 700.00, but that is nothing compared to those who self-pay.

I, too, suffered depression, wacky cholestrol, as well as hypothryoidism and was consider pre-diabetic. If you have all of your lab results prior to the consultation, it will help speed up the insurance approval. My Endo did all of my lab work before he determined that I needed the lapband. So I was able to provide copies to my doctor and insurance was approved two days later. BCBS FEP moves very fast. Infact, I will scheduled for surgery 30 days later after approval. I had to move fast with all of my pre-op stuff - psych eval (which I see a psychiatrist regularly anyway, so easy clearance letter), clearance letter with primary care, cardiologist, etc. Infact, my primary care detected some abnormal EKG's and sent me out to see his cardiologist. WEll, I didn't listen to him and instead turned to the Bariatric cooridnator at Fair Oaks, who was extremely helpful in getting me in with their cardiologist ASAP. It makes it easier because they can access all of their documentation right there. Anyway, Inova Fair Oaks hospital was WONDERFUL! And I even had a private room!

Back to the subject... The process is very fast with my docs as well as with the hospital. I didn't have to wait several months.

You will still be required to pay for all of you doctor's visit co-pays of 15.00 and any difference with additional lap work for pre-op. If you haven't found a doctor, I highly suggest Dr. Tran and Dr. Halmi! Read their bios. They are absolutely fantastic. And I must admit that I was extremely lucky to have great doctors under the FEP Plan! It surprised me.

I hope this helps. email me should you have any questions! I wish you the best!

Baires · June 6, 2008

Hello,
I had the band done 4 weeks ago. We also have BCBS FEP Standard. FEP has a distinction center for weightloss surgery in Fair Oaks (Inova Fair Oaks Hospital). They are in-network and will ease the cost of the surgery.

Thanks, Trinity. I did notice Inova Fair Oaks and Johns Hopkins in Baltimore listed as Centers of Excellence or something of the sort, so I'm going to look into both. Did BCBS require you to show records of a supervised weight-loss plan that didn't work before aproving the surgical alternative?

Thanks again!

Edited June 6, 2008 by Baires