Mississippi Federal BCBS and GEHA

[MsGulfCoast 0]

Husband is federal employee and we currently have GEHA for insurance. Husband wants to switch to MS Federal BCBS next open enrollment in October or November. Looking for any and all information regarding having surgery through this insurance provider. I have a BMI of 40 with minimal comorbidities; never been diagnosed with diabetes or hypertension although both are very prevalent in my family. Will BCBS approve under this scenario?

I am trying to determine if BCBS is "better" than GEHA and whether or not we should change. I am leaning toward switching.

I look forward to any and all information you have regarding the above.

Thank you very much!!!

[shome 0]

Hello,

I live in WA state & we switched last open season to BCBS Fed. Emp. Basic option. We called them before we made the switch & asked lots of questions. It seemed too good to be true. But it was true so we switched.

Not sure if the coverage is the same for you but ours is.... $100 copay per surgeon (I had 2), & the EGD was considered a surgery too. $30 copay per specialty visit (it is considered a specialty, so that is the copay for every office visit including fills b/c they are a Weight Loss clinic where I go) my overnight was only a $40 copay b/c they didn't consider it an inpatient stay it was called a "short term stay" or something to that effect, but I was prepared for the $100 per night stay anyway so it was good. Hmmmm, and any difference in the labs & such that they have a cap on. So far I have paid $185.00 & my surgery was in June.

Just call them & ask specific questions.

Best wishes!

[MsGulfCoast 0]

Did BCBS require 5 years' worth of documentation of being overweight? Mine does and I don't have that kind of documentation. I will probably have to stick with my current insurance which does not require that extensive documentation. I will pay more out of pocket but I will be able to have the surgery a lot sooner.

Thanks for your information. You sound like one of the lucky ones with excellent insurance. : )

[shome 0]

When I went to the information meeting for the WLS clinic they gave me a packet of paperwork that asked those questions. I had to go 10 years back. But if you have been to the Dr.'s over the past 5 or so years there should be a weight note in each visit. They usually weigh you everytime you go in. That should be proof enough.

Funny though, it seems now that I had the surgery my regular Dr. visits don't weigh anymore. :smile2:

[bklyn1984 0]

Did BCBS require 5 years' worth of documentation of being overweight? Mine does and I don't have that kind of documentation. I will probably have to stick with my current insurance which does not require that extensive documentation. I will pay more out of pocket but I will be able to have the surgery a lot sooner.

Thanks for your information. You sound like one of the lucky ones with excellent insurance. : )

Here's what my benefits says I have BCBS FED Standard Option:

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.

While it does not mention anything about the length of documentation my surgeon took six months worth so I would check with your surgeon's office.

I have a surgical coordinator who is very familiar with their requirements so I am sure your surgeon's office should be too. I would explain the situation and tell them about what you have now and what you are considering and go from there. I used to have NALC and they were an absolute nightmare.

I am so glad we switched during the last open enrollment. Everything that I have done already has been paid for minus my responsibility. I was told that they I would pay out 10% after they pay out 90% for the procedure with no co-pay. The 10% is not based on what your surgeon charges. It is based on what BC pays out. The same pay out for anesthesia and $100.00 per night in the hospital.

Here's the link to the site choose one option at a time to see the difference it's for this year: New Members Index