Question about BCBS GA Federal

lcjackson · August 28, 2008

Hello everyone,

:smile2:

I am in the process of preparing to get banded. I have completed all of my pre procedure stuff and have been submitted to by insurance co. I was sumbitted on July 11,2008. I have BCBS FEDERAL GA. It has been about 6 weeks and I still don't have an answer. I am getting so impatinet and nervous. I actually called today but still no answer. The customer service rep told me that I didn't have to actually get an approval before I have my surgery becuase my plan does not require it. I am not too comfortable with that. I will probably have the surgery then they will deny me and I will be stuck with the bill. :lol: I don't think so. Is anyone familiar with this not having to be approved proior to surgery. Please I need some help. Any suggestions are welcomed.

LisaB411 · August 28, 2008

I have BCBS Federal in VA. I didn't get an official "approval" either, but they paid everything they were supposed to. My doctor said they are usually really good, and are one of the easiest plans to work with.

Do you meet their criteria for approval? (BMI over 40? Co-morbidities?) If so, I wouldn't worry too much.

pvanzant · August 28, 2008

I had BC/BS FEP and had it approved in 1 week.

JRFAN88 · August 28, 2008

I have BCBS Federal also. It took less than 1 week to find out. I too did not get an official approval but as far as I know everything has been paid. I was out of pocket about $1500 I think.

pvanzant · August 28, 2008

Just make sure you file your claim soon after if you are disputing a charge, otherwise it will be too late

lcjackson · September 1, 2008

Thanks for your responses. I think that I have finally been approved. Even though I missed the call I had a message on my voice mail Friday from the surgeon's office. They were calling to schedule my surgery, Hoooray. I can't wait to talk to them and get a date. Thanks again.:thumbdown:

RandiW · September 19, 2008

I have BCBS Federal also. It took less than 1 week to find out. I too did not get an official approval but as far as I know everything has been paid. I was out of pocket about $1500 I think.

JRFAN88---

I am in the process of see keilin/Heiker in Texarkana. I saw them for the first time 8/25/08. Still have not heard back from them on my insurance requirements. I have federal BCBS. What ecaxtly did you have to have for the surgery??? Also, how long did it take for you to get everything in order to have the surgery?

Thanks!!!

JRFAN88 · September 19, 2008

JRFAN88---
I am in the process of see keilin/Heiker in Texarkana. I saw them for the first time 8/25/08. Still have not heard back from them on my insurance requirements. I have federal BCBS. What ecaxtly did you have to have for the surgery??? Also, how long did it take for you to get everything in order to have the surgery?

Thanks!!!

I had to have 6 months documented weight loss attempt. It did not have to be doctor supervised. I had several different personal journals, an Oprah one, a Body-for-Life journal, & just a notebook where I had kept up with my dieting. I had to show 5 years of weight history. (I think it was 5). They just got my records from my family doctor & my OB/GYN for that. I have always been a yo-yo dieter so I my BMI probably fluctuated from 33-41 within those 5 years. I went to see them then within 2 weeks had a sleep study & a psyche evaluation. About 2 weeks after that I got the call from them to schedule surgery. I had the surgery less than 2 months from my first visit.

They must be busy over there. My son told me they called last Friday to reschedule my next appointment & I called them back this past Monday & left them a message to return my call & I haven't heard back from them yet. I usually have good luck though sending an email to Mrs. Betty. You can find her email on their website www.noscales.com.

Anyway, let me know if you have anymore questions. I really love the doctors there & Mrs. Betty & Debbie & Jamie. I try to make most of their support group meetings too.

RandiW · September 19, 2008

I have done WW in the past and done self supervised weight loss. I have lost a lot but gained it back time and again. I am assuming this does not matter, and that your weight can go up and down. I can produce some journals and give them things in writing that I have done, just nothing official or from a doctor. And of course I have 5 years of weigt history from medical records.

Thanks!

JRFAN88 · September 22, 2008

I have done WW in the past and done self supervised weight loss. I have lost a lot but gained it back time and again. I am assuming this does not matter, and that your weight can go up and down. I can produce some journals and give them things in writing that I have done, just nothing official or from a doctor. And of course I have 5 years of weigt history from medical records.
Thanks!

It sounds like you will have everything they need then. I was worried about my BMI not being 40 for the entire 5 years because like I said I was a yo-yo dieter so one year I was up then the next year was down. I could never keep the weight off. That's what I think the lap-band is going to help me with the most, is keeping it off. The weight still comes off slowly like before but usually by now I would already be back to gaining. But now I can't fall off the wagon like I used to could. Good luck to you! Keep me posted.