Question:
How anyone use BC/BS PPO Federal plan on TN for WLS.

I called the company and was told they don't do pre-approval. A medical team determines appoval of the Gastric bypass procedure after it's done and the surgeon submits the claim. A pre-cert. must be done for the hospital stay. Does this mean they could deny the procedure after the fact??? Has anyone out there used this insurance? Thanks    — CLAUDIA P. (posted on December 26, 2001)

December 26, 2001
I also have BCBS FED. I got pre approved for the hospital stay. If you are 40 BMI, no if ands or butts they will pay.. they have no little hidden agenda. If you are not 40 BMI then I dont know what happens. I am JUST 40 BMI.I have not had my surgery yet.
   — Connie M.

December 26, 2001
hi claudia. i have fed bc ppo.i live in nevada but had my surgery in arizona. my doc had no problem whatsoever taking my insurance. his office mananger said its because they get paid every time. the condition bc requires is being 100 or more pounds over weight. they dont care about co morbids or bmi. & yes u were told right. just because they give an approval doesnt mean they will pay...but if u meet the criteria they do. & yes u still have to pre cert for the hospital. when i called bc to do this they told me the hospital had already done it & they gave me a confirmation number. they wont notify u...only the dr & the hosp. the nurse then went on to tell me that i was using the most popular wl surgeon in the arizona network & they approve as soon as they see his name. has to be true cause my approval took less than 48 hours. to protect ur financial security, be absolutely sure ur surgeon is a \'bc preferred\' & so is the hospital. u cant go wrong with \'preferred in the network\'. good luck to u hun.
   — sheryl titone