Blue Cross/Blue Shield Federal - Help?

tracycoder
on 1/11/10 10:49 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!
beccay10
on 1/11/10 10:53 am - Frankfurt, Germany
Hello,

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 11:03 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
                                        

MacawMother
on 1/11/10 11:04 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.
ladybugnessa
on 1/11/10 11:05 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.
Nessa
Ticker is from Day of Surgery.. weight goal is personal preference as I've MET my doctor's goal

--


HG/SW/CW/GW
286/253/150/151


1mom4boys
on 1/11/10 11:06 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. 

Deb

"I'm kind of paranoiac in reverse. I suspect people of plotting to make me happy." -Seymour Glass
ladybugnessa
on 1/11/10 11:11 am - Owings Mills, MD
actually with FEP-BC/BS you MUST use a COE for the hospital.
Nessa
Ticker is from Day of Surgery.. weight goal is personal preference as I've MET my doctor's goal

--


HG/SW/CW/GW
286/253/150/151


(deactivated member)
on 1/11/10 11:08 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.  :)
teressab
on 1/12/10 5:03 pm - 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!
tracycoder
on 1/11/10 11:13 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!
tphillipslaw
on 1/11/10 11:47 am
RNY on 01/12/09 with
I have BC/BS federal too.  I had my surgery 1/12/09.  My BMI was 40 with no co-morbidities.  I had the RNY.  The insurance approval process was very easy.  I didn't have to show evidence of a supervised diet and I didn't have to have the psych eval.  I was also scheduled for the lap-band, but I changed my mind last minute and BC/BS had no problem changing my approval from lap-band to RNY.  It was a VERY easy process! 
imkim
on 1/11/10 12:42 pm - Chatsworth, CA
Another Federal employee with BC/BS here. I was amazed at how quickly the process took. I think I had a BMI of 43. I also had everything else that came along with being over weight. I didn't have to do the 6 month diet. I did have to do the psych eval but I think that is routine with my DR. It took about 1 1/2 weeks to get approval for the rny.

Good luck

Kim

 
This includes my pre-surgery weight

MsBatt
on 1/11/10 1:24 pm
My reply has nothing to do with insurance, but with your 'very high cholesterol'. Have you considered a malabsorptive surgery rather than the Band? With the RNY, at one year post-op you'd only be absorbing 62% of the fat you eat, rather than the 92% that 'normies' do. And the DS does even better---DSers only absorb 19% of dietary fat.

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!!!
JudiJudi T
on 1/11/10 1:37 pm
 High cholesterol isn't always just diet based ... so I'd think twice about picking a surgery just based on that.  That said, I have BC/BS FEP and approval was fast and easy.  
(deactivated member)
on 1/11/10 2:33 pm
Boy are right about the cholesterol issue!  My cholesterol untreated is 336.  I eat low fat...always have, but it doesn't matter.  2 of my sisters are 2 years out with their VSG, and both are still on cholesterol meds.  We are so lucky to be "genetically predisposed." 
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..
anastasia45238
on 1/11/10 3:42 pm - Cincinnati, OH
RNY on 02/05/10 with
I have BCBS federal basic and I was approved with the first letter! All I had to do was see the Nutritionist and a Psychologist and it was home free! I chose basic because of the wonderful people's advice on this board and it worked like a charm. I am having RNY because I want permanent wl. With my insurance, you have to pick someone in the network and pay a certain amount out of pocket, but my costs have been minimal and the rewards have been so wonderful. Ask many questions on this board and please, follow their advice! Good luck and God bless! See you in the losers circle! 
            
cdawson0425
on 1/11/10 6:28 pm - Houston, TX
Hi tracycoder

My name is Channell. BCBS Fed is about the only insurance that cover the sleeve procedure that I had done 03/12/2009 I have loss 104lbs so far. I love it. Good luck to you.
tracycoder
on 1/12/10 4:41 am
REALIZE Band on 04/22/10 with
Tonight I'm having my sleep study done to confirm my sleep apnea.  It was originally scheduled for this saturday but I figured why should I blow a weekend sleep-in day!  I'm NOT looking forward to it!  I have this picture in my mind of me trying to sleep in a room with a big two-way glass window and people staring at me all night. Ugh!  I hear it's not really that bad, though, so we shall see!
LouLou7
on 1/12/10 1:39 pm

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.

LouLou7

ncredibleeswyt
on 9/23/10 7:11 pm - NY
Did you have to pay that after your surgery was complete or did you have to pay at the time of your visit?

NcrediBleeSwyt