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| Author | Message |
 | Post Date: 3/26/08 2:00 pm Last Edit: 3/26/08 2:07 pm
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I have 
 Norman, OK Member Since: 03/12/08 [Latest Posts] | Post Date: 3/26/08 2:43 pm Last Edit: 3/26/08 2:43 pm Federal Employee Program Blue Cross/Blue Shield Standard Option did begin covering VSG (they had already been covering for RNY and LapBand) as of 1-1-08 for those with BMI of 40 or >, or BMI of 35 or > with 2 co-morbid conditions. However, they only recognize certain co-morbid conditions. I'm not sure about Basic Option. Good Luck! Shelly |
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| Post Date: 3/26/08 2:45 pm   REALLY!? THANKS!!!!!! That will have me smiling for the rest of the day! (I have PPO by the way). I don't know what that is or if that means anything, but thanks again! |
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Norman, OK Member Since: 03/12/08 [Latest Posts] | Post Date: 3/26/08 2:55 pm Last Edit: 3/26/08 2:56 pm Yep, we have PPO, too. Although you can use physicians out of network, the PPO options save $.
Go the the FEP BLUE website and you can download a benefits booklet. Look at page 46, I think. ; )
Also, the only qualifying co-morbid conditions I have been able to get them to verify are diabetes, high cholesterol, and high blood pressure. However, I'm not 100% certain that these are all of them.
Shelly |
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 Member Since: 10/15/07 [Latest Posts] | Post Date: 3/26/08 3:34 pm Last Edit: 3/26/08 3:44 pm Hi Harris,
Did you actualy contact BCBS Fed and gave them the code for VSG and they said they cover it? I seen on page 46 they covered gastric restrictive, gastric restictive with malabsorption and gastric malabsoptive procedure.
Now I'm not sure but someone told me the sleeve is call gastric restrictive procedure other than the Lap Band.
What you think? I just hope they have added this. I will be submitting my paper work next week, I sure pray for us all.
Just let me know!
Sylvia |
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Norman, OK Member Since: 03/12/08 [Latest Posts] | Post Date: 3/26/08 7:08 pm Yes,, I contacted them and they verified it by phone. I did have the CPT code and had it verified that way, as well. As of 1-1-08 they started covering VSG, as well as RNY and LapBand. I also contacted an insurance coordinator specialist in FL and she confirmed that they have had several patients VSG's covered by Federal Employee Program BCBS. They do not do a preapproval process. You just have the surgery and then the claims are submitted and paid. Just remember that if your BMI isn't 40, or greater, that you need 2 co-morbid conditions and a BMI of at least 35. They would only verify diabetes, high blood pressure, and high cholesterol as qualifying co-morbid conditions when I spoke to them by phone. Best Wishes!!! Shelly |
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 Unionville, TN Member Since: 03/05/08 [Latest Posts] | Post Date: 3/26/08 3:30 pm I have BC/BS federal and I had my surgery Monday. I did have high blood pressure, diabetes, and sleep apnea. I was approved quickly and did not have a waiting period. Best of Luck!   |
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Member Since: 10/15/07 [Latest Posts] | |
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 Los Fresnos, TX Member Since: 07/01/03 [Latest Posts] | Post Date: 3/26/08 4:05 pm Hi there, my name is Kris. I have the BC/BS Federal Insurance. I work for US Border Patrol. I was approved first for the RNY procedure. At first that is what I thought I wanted. After being approved for that/on the same day, I decided VSG. One phone call from my Dr. office to Insurance co. and was approved for VSG instead of RNY. Love Fed Insurance!!!!!! My procedure was on Dec. 5, 2007. I have lost total of 89 lbs. 15 pre-op. I LOVE MY VSG!!!!!! |
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| Post Date: 3/26/08 4:22 pm Blue Cross Blue Shield is known for their approval process. My dad sent in his papers for aproval a year ago and got the go ahead a week later. He had RNY though. I'll keep my fingers crossed! |
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 san antonio, TX Member Since: 04/15/07 [Latest Posts] | Post Date: 3/27/08 6:48 am i have the federal program and was covered for my vsg last april 24th, i have lost 84 pounds since then. no waiting period, i do have high blood pressure but that was it. hospital one hundred dollars for 4 day stay, and surgeon was 10% upfront. good luck. they will send you and your surgeon an approval letter about 3 weeks before your surgery.
good luck,
laurap. laura p.  |
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| Post Date: 3/27/08 4:44 pm Thank you Laura. How come you had to stay in the hospital for 4 days? Did something go wrong or was that the amount of time they required for you after surgery? I think the day I receive approval will be one of the top 3 happiest days of my life! |
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 Lampasas, TX Member Since: 10/13/07 [Latest Posts] | Post Date: 3/27/08 5:34 pm In October 07, I was told by the states doctor that VSG was not covered 99% of the time. I went as a self pay to Mexico (Dr Alvarez), came home and filed an "overseas claim". Everything was reimbursed but a $70 copay! Evidently they do cover it, but just have to wait on pins and needles after surgery to find out. Although, since someone said the plan changed in 2008, looks like smooth sailing...by the way, I have Blue Cross Blue Shield, Basic Option. |
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Member Since: 01/27/12 [Latest Posts] | Post Date: 1/27/12 6:29 pm I have BCBS Federal and I'm wanting to have the VSG, I've been told it could take 4-6 months until the date of surgery, due to waiting for the insurance to approve it, I don't think my nerves can wait that long.. ugh! Does it really take that long? What are all of the requirements, such as diets before surgery? |
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Lakeport, CA Member Since: 01/11/10 [Latest Posts] | Post Date: 1/11/10 9:48 am I'm looking to have a VSG with Dr. A and have a scheduled date April 5th, 2010. I was lead to believe I will have to self-pay because insurance companies do not cover VSG. After reading a few comments and yours............I'm thinking there is a chance. I have blue shield of california insurance. What is an overseas claim exactly? Any step by step info would greatly be helpful. I have a BMI of 42 so I probably don't need 2 other conditions. It would be wonderful for some reimbursement!!!!!!!!!!!!!!!! Maree |
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