Blue Cross/Blue Shield Federal - Help?

on 1/11/10 2:49 am
REALIZE Band on 04/22/10 with
Hello!  First post here; I'm just starting on my weight loss surgery journey.

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!
on 1/11/10 2:53 am - Frankfurt, Germany

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.

Good luck!
Mountain Mama
on 1/11/10 3:03 am - Evansville, IN
I have Federal Blue Cross/Blue Shield, but didn't have the lapband.  I had RNY.

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

on 1/11/10 3:04 am
I have BCBS Federal plan and I just had surgery on December 9th.  They approved me REALLY fast (starting BMI over 50 with comorbidities).  In the beginning I called them and they cover the lapband and RNY.  I didn't have to do anything extra to show proof of weight loss attempts.  All you have to do is call (BCBS) and ask the questions and they'll tell you.  Good luck!
MacawMother   Heighest/333        Goal/177        Current/152  =  total loss of 181 lbs
Looking into plastics now.   Would like a lower body lift, thigh lift, & boob job.
on 1/11/10 3:05 am - Owings Mills, MD
FEP here too.  had RNY  with NO problems.  I had a BMI over 40 but NO comorbidities.  

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.
Ticker is from Day of Surgery.. weight goal is personal preference as I've MET my doctor's goal



on 1/11/10 3:06 am - Spokane, WA

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 3:11 am - Owings Mills, MD
actually with FEP-BC/BS you MUST use a COE for the hospital.
Ticker is from Day of Surgery.. weight goal is personal preference as I've MET my doctor's goal



(deactivated member)
on 1/11/10 3:08 am
 I have BCBS Fed and am in the approval process.  My surgeon assures me they are EASY to deal with as far as WLS is concerned.  Ive spoken to them multiple times to inquire about different surgeries and pre-op testing- they cover it all as long as you are in network.  They do not require 6 months on a Dr supervised program, rather only 1 month (which is done during your pre-op with your surgeon).  Your surgeon will be well versed in acquiring approvals, and will know how to word things and what to submit to get you approved.  Just make sure to follow their advice to a "T" and remember its always better to OVER document, than scrape by.  :)
on 1/12/10 9:03 am - Whitley City , KY
I have FEP Blue as well.  I had Lap-Band in 2007 with a BMI of 38.  I did not have to have any prior supervised weight loss programs and everything went pretty fast with approval.  The only "surprise" I had was when I got my bill... the lap band was considered "durable medical equipment" and my co-pay was 30%. ($2,200)  I wasn't ready for that one.  Guess I should've done my homework! 
Good Luck with your surgery!
on 1/11/10 3:13 am
REALIZE Band on 04/22/10 with
Thank you for all of your prompt replies!!!  I am grateful that so many helpful people are willing to share what they know about this with me!
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