BCBS Fed?????

[EmpressLizBunny 18]

my father is a fed employee and I'm under his plan

we were going to pay out of pocket because everyone told us that to get approved for insurance we had to go on a 6 mo diet and we did not want to do that so my surgery date is 1/9/09 but i now see on this board that BCBS fed does not require a 6 mo diet but in 09 will require pre certification what exactly does this mean????

oh i forgot to add that my bmi is 51

thanks in advance Liz

Edited December 17, 2008 by EmpressLizBunny

[jasmin20 0]

HEY I'm also under my dad's BCBS fed plan. I did not have to do a 6 month diet. The only thing I had to do was go to the consultation and have my DR. submited a form to BCBS and in six days they approved it. I wish you would have tried the ins. first it would have saved alot of money. But I have no idea about the pre- certification.

[jasmin20 0]

oh yeah maybe u can still try the ins. and can get your money back what you paid out of pocket.

[EmpressLizBunny 18]

i havent paid yet they said i could pay on the date of surgery 1/9/09

[creed2474 0]

From what I learned in the last month or so....

Before Jan 09 pre-auth was not given..... so, say if you didn't do enough paperwork or diet history...or whatever else they required....and you had the surgery...if it was declined... you would be up the creek without a paddle and would be responsible for the bill. But, from my understanding if your BMI is over 40 then that is all that is required and you shouldn't have a problem. But, say if you were under 40 and your doctors office didn't submit something.... it would probably be declined.

Pre-Auth just means it's approved and everything is submitted correctly.

This surgery is usually done out-patient...but, in order for my doctor to get the pre-auth (submitted this month) they required me to be in the hospital over night. And BCBS gave them the pre-authorization.

I hope i'm making sense....

I did not have to do anything as far as the 6 month diet, the nutritionist, or the psych eval. I saw the doctor... first visit... he recommended me... I met the BMI ... and I was approved the following week by the insurance company.

Edited December 19, 2008 by creed2474

[EmpressLizBunny 18]

thanks for clearing that up so pre auth is a good thing?

[snowbird 2]

Call BCBS right now and they can tell you exactly what you would have to do to get the surgery covered. You probably still have time to do it before your scheduled surgery date.

[bklyn1984 0]

thanks for clearing that up so pre auth is a good thing?

What's new for 2009 when it comes to pre-certification is for outpatient bariatric surgery:

This applies to both Standard and Basic Option you can find out more by going to the website www.fepblue.org and downloading the 2009 brochure.

You must now obtain prior approval for outpatient surgery for morbid obesity, outpatient surgical correction of congenital anomalies, and outpatient surgery needed to correct accidental injuries (see

Definitions) to jaws, cheeks, lips, tongue, roof and floor

of mouth. Previously, these types of services did not require prior approval.

Like it's been mentioned here I would call BCBS Fed at the number on the back of your father's card for further clarification.

[creed2474 0]

When I called BCBS they told me the wrong things. Even though it is a FED plan... it is administered through regular BCBS and they don't get their stories straight.

Also, doctors offices require you to do things you are not required to do. They are confused also I think....

I finally found a doctor where the insurance specialists knew what they were doing. My first doc appt was 12/3/08 and I was scheduled for surgery 12/30/08. That is how good they are!

I would first call the doctors offices.... ask them what is required for the surgery with the federal plan..... if the BMI is over 40 and they are telling you all this stuff is required... then you need to call someone else or have them look it up to correct what they told you. I couldn't get the ones here to budge..... so, of course I found one that knew what they were doing.

[bklyn1984 0]

When I called BCBS they told me the wrong things. Even though it is a FED plan... it is administered through regular BCBS and they don't get their stories straight.

Also, doctors offices require you to do things you are not required to do. They are confused also I think....

I finally found a doctor where the insurance specialists knew what they were doing. My first doc appt was 12/3/08 and I was scheduled for surgery 12/30/08. That is how good they are!

I would first call the doctors offices.... ask them what is required for the surgery with the federal plan..... if the BMI is over 40 and they are telling you all this stuff is required... then you need to call someone else or have them look it up to correct what they told you. I couldn't get the ones here to budge..... so, of course I found one that knew what they were doing.

I totally agree with you. I would have had my surgery much sooner than I am if I had been more persistent. It worked out for the best though because last week I had to have emergency hernia repair and the surgeon was from the same practice who are doing my lap band, I had surgery in the same hospital, and met some of the staff I may see again on the 9th. The hernia surgeon was very familiar with lap band surgery so he was very understanding and waited until after surgery to tell me if everything was okay with going forward and today I found out I am still good to go.

BCBS Federal from what I have been told by someone who approves these files are completely separate from regular BCBS. I was told that they follow exactly what is said about this surgery in the Service Benefit Plan Brochure. I was also told BCBS Fed is from negotiations done between BCBS Association and US OPM not individual states.

[EmpressLizBunny 18]

i was aproved!!! yay!!! only 1 more week to go

[bklyn1984 0]

i was aproved!!! yay!!! only 1 more week to go

That's great! :tt2:

My surgery is on the same day as yours and I am on day 9 of the pre-op liquid diet. Friday cannot not get here quick enough for me.

[froggin4colorado 0]

I too have BCBS through the govt. All of these years I have tried other plans and haven't gotten approved because I am too healthy- I am only obese and have no health problems. I haven't tried this year with BCBS though. Do I need other medical problems to qualify? I will call this week and see what they tell me. But any insight would be good. Thanks!

[EmpressLizBunny 18]

I too have BCBS through the govt. All of these years I have tried other plans and haven't gotten approved because I am too healthy- I am only obese and have no health problems. I haven't tried this year with BCBS though. Do I need other medical problems to qualify? I will call this week and see what they tell me. But any insight would be good. Thanks!

all i know for sure is that a BMI of 40 or more qualifies you w/o co-morbidies

i suspect that its a BMI of 35 with co-morbidies because that is most comon but i dont know for sure try posting your own thread to get more spefic info as that will get more viewings i think (not that i am in any way saying you should not have posted in my thread or telling you to go away i do not mean to sound mean or harsh but one often cant tell how people will read something)

[yorkiemomof3 0]

Congrats on your approval - I to have BCBS Fed as primary and I hve ChampVA as secondary.I read somewhere that some insurance company's do not cover the fills - do you know if BCBS Fed covers fills or do any of ya'll know something that it does NOT cover. I have 35 BMI w/High Blood Pressure and GERD w/aspiration causing bronchitis - I really need to get the surgery soon as aspirating in the night is not only scary and painful but dangerous. I was glad to hear that ya'll were not having to do the 6 month diet. Any additional infor ya'll can give is appreciated - Beth:confused::wink_smile: