Blue Cross/Blue Shield Federal - Help?
Does anyone else have Blue Cross/Blue Shield Federal insurance? If so, did you have a problem getting them to pay for your LapBand procedure?
I am right at 35 BMI and I have very high cholesterol, borderline hypertension and sleep apnea. What are the chances I'll be covered? Also, do they require that you show proof of a weight loss program for the past six months?
Thank you so much for any help you can give me. This is all so overwhelming for me and I'm not sure exactly where to start!
I have BCBS Federal and I am overseas. I am right on the boarder to have bypass. So we will both have to see how it works out! My BMI is 37, but I have PCOS and hypothyroid. After being in Germany and eating so many brawurst I probably have high cholestrol now too!
Have you met with your surgeon's office? They should know how to proceed. It is kind of part of their job to help you convince the insurance company too.
I had a BMI of 37.9 starting out with my comorbities being hypertension, borderline diabetic and COPD. I didn't have to document a weight loss program, but was expected to follow the dietary guidelines set forth by the Bariatric Center -- recording my daily food intake for each visit. However, they only sent a sampling of my food jornals with the approval paperwork.
Mine was approved with the first submission and it was back 5 days after it was faxed.
Pre-Op 3 mos. post op 5 mos. post op At Goal Surgery Date - 12/10/2009 Goal Met -8/26/2010
Looking into plastics now. Would like a lower body lift, thigh lift, & boob job.
DH had his approved the same time mine was his BMI was over 50....
we did not have the 6 month weight loss requirement. OUR SURGEON however had a 3 month requirement WiTH LOSS... so we had to do that for him.
I don't have your insurance but I work for a different insurance company. Here is how it works and you should not have any issues.
1) find out what the clinical criteria is for your plan. Specifically what BMI and comorbity requirements they have. Any other requirements.
2) the FEHB proffesional claims (doctor time) and facility claims (hospital) are processed seperatly. You want to make sure that both are contracted with your plan.
3) ask for a checklist that your provider must complete prior to submitting your pre - authorization request.
If you ask lots of questions. Write down who and when you talk to people if they deny that information will help you with an appeal. Don't be afraid to ask for an appeal based on bad information. That is why most appeals are won.
"I'm kind of paranoiac in reverse. I suspect people of plotting to make me happy." -Seymour Glass
on 1/11/10 11:08 am
on 1/12/10 5:03 pm - Whitley City , KY
Good Luck with your surgery!
It's done wonders for me---rather than the 'very high cholesterol' I had pre-op, at six years post-DS my total cholesterol is 112. And I eat bacon for breakfast every morning!!!
They are, however, off the diabetes meds, asthma meds and CPAP. 3 out of 4 isn't bad...it's worth the journey. They both look WONDERFUL! I'm looking forward to my RNY on Jan 25th.
As a side note, my sisters had the same surgeon. He doesn't perform the DS, but did give them detailed information on that procedure as well as RNY, lapband and VSG. He wanted them to make an informed decision they could live with. They both chose the VSG.
My PCP and my surgeon both described all 4 procedures with me for the same reason. I chose RNY. It's the choice I feel I can live with.
I wish all surgeons were this foreright..
I'm Blue Cross/Blue Shield Federal as well, with a BMI of 43 and comorbidities. All I had to do was fax a copy of my insurance card to the doctors office, and they turned it in on a Friday and I had approval on the following Tuesday. After the approval I faxed them the rest of my paperwork (letter from doctor, application packet) and scheduled the surgeon visit and the psychology eval. Within two or three weeks of approval I had seen the surgeon, had my psychology evaluation and was scheduled for surgery. No pre-op diet required.
I had all four options (band, rny, DS, sleeve) and I chose sleeve. I went to a Center of Excellence. Wonderful surgeon, wonderful hospital, wonderful follow up, wonderful experience.
The financial advisor at the doctors office said BC/BS federal is the easiest insurance to work with of all of them.
Oh, you didn't ask, but all I had to pay was a $300 co-pay to the surgeon and a $200 co-pay to the hospital. Everything else was covered.