BCBS Federal Employee Plan: Inpatient or outpatient?

[Baires 0]

I wanted my surgeon's office to treat the procedure as inpatient, because (a) my coverage would be 100% instead of 70% and (:smile: that forces the insurance company to pre-certify the hospital stay which means they agree to medical necessity prior to the operation, which they don't otherwise do. My doctor's office says that they can only do it as outpatient and insurance companies don't let them do it as inpatient. Is this true? Has anyone done it as inpatient with BCBS in the DC area? If so, who was your doctor?

Thanks!

[SuzanneG 1]

I did it as in-patient, but I drove to Richmond. I LOVE my doctor. Not sure where you live. I live in Fredericksburg and work in DC. If you want more info, let me know.

[Chellets 0]

I don't know if they are all the same, but I have BCBS FEP (basic) in Indiana and I just have to pay a $40 co-pay total for an out-patient lap-band.

[Baires 0]

Thanks to both for replying. Did you get a pre-certification letter from BCBS?

[SuzanneG 1]

For me, I was intitially denied, then had to appeal, then got the letter. I was led to believe that I needed to stay overnight because of my insurance, but I never questioned it.

One thing you may want to check on is fills. I'm charged a $100 co-pay, my surgery co-pay every time I get a fill because they consider it "surgery" if a foriegn object enters the body. :-( The part I couldn't understand is why my friend, who paid cash, had all fills included for a year.

[justmel1957 1]

It also depends on whether you have the Basic or Standard Fed BCBS option. With basic option, I only pay $30 per fill/visit co-pay. I was approved for an overnite with a $40 co-pay and rec'd a approval letter prior to surgery. (not a pre-cert number, that is only done for in-patient status (over 23 hr stay). With basic option, you just have to be sure that your provider and hospital are BCBS providers. If not, there is no coverage at all. With standard option, there is some coverage if you are out of network, but it is less). Also, the state is which you are having the surgery is the state that approves or denies. I live in Illinois, but had my surgery in Kentucky. Kentucky was the state that reviwed my submission and sent approval.

[SuzanneG 1]

That's interesting. I have Basic Option and my surgery co-pay is $100. Are they different from state to state? I work in DC and live in VA.

[justmel1957 1]

That's interesting. I have Basic Option and my surgery co-pay is $100. Are they different from state to state? I work in DC and live in VA.

Check the benefit page on the on line Fed BCBS site. It depends I think on if you are being considered a 23 hour patient (which is essentially out patient) or a full admit.

[SuzanneG 1]

Is your surgery co-pay always $30? I even pay $100 when I have a fill. BC/BS said is a foriegn object enters my body, that's considered "surgery". :-(

[justmel1957 1]

Is your surgery co-pay always $30? I even pay $100 when I have a fill. BC/BS said is a foriegn object enters my body, that's considered "surgery". :-(

My hospital overnight/surgery was a $40 co-pay. Everytime I see the doc for a visit or a fill it is $30. But, perhaps the difference is my doc does not fill me underfluroscopy. Does yours?

[pennyt 14]

I have FEP Basic Blue Cross. My surgeon gave me the option of inpatient and outpatient. (I chose out-patient for various reasons.)

I have been billed $100 for the surgeon, and then about $1,100 for the hospital supplies, since out-patient requires us to pay a certain percentage of the supplies used and that includes the cost of the band.

[justmel1957 1]

I have FEP Basic Blue Cross. My surgeon gave me the option of inpatient and outpatient. (I chose out-patient for various reasons.)

I have been billed $100 for the surgeon, and then about $1,100 for the hospital supplies, since out-patient requires us to pay a certain percentage of the supplies used and that includes the cost of the band.

Huh..........I didn't have to do that. I only paid $40 total to the hospital. The only thing I had to pay xtra for was the bill from the doc who did my contrast xray for the swallowing eval the next morning. He was not a BCBS provider. It was $82. Must be in how the facility submits the bill?