Question:
Does anyone have any current information on getting WLS with BCBS Federal?
From what I can tell, there hasn't been much posted recently about the Federal BCBS plan (11-2002). Can anyone share any information they have about the precertification process and any roadblocks they might have hit? Does BCBS Federal still not precertify as noted in earlier posts? It is in the plan book that they will cover WLS as long as the patient is at least 100 lbs. or more over weight. — Lana R. (posted on November 27, 2002)
November 28, 2002
I have fed bcbs. They pay for quite a bit! They paid NOTHING; however, on
the first visit. If you have all your deductibles, and you are pre
registered, your hospital bill should only be $100. I didn't put all this
info on my profile yet, I am 2 months post op and not sure all the bills
are in yet, I plan on doing this in the next week or two. So check my
profile then, or e-mail me if you have any more questions.
[email protected]
— Tammy .
November 28, 2002
I currently have Federal BCBS and was told by BCBS that they would not do a
preapprove and to go ahead and have the surgery and then they would make
their decision on what they would pay. My surgeon's office even called
BCBS because they couldn't believe that any insurance would say that when
it is a minimum of $30,000 for the procedure. BCBS told them the same
thing. It is currently open season for Federal Employees so I am switching
to Mailhandlers, who assured me that I was qualified and they would approve
my surgery without a second thought.
GOODLUCK!
— C. Zibrowski
November 28, 2002
Hi - I have FEP BCBS and am having surgery 12-5-02 Open RNY. I went through
a MAJOR panic attack because I found out the same thing you did. One
surgeon I went to said he'd waive his upfront fee for me BUT the
Anesthesia group made me pay their fee upfront and the hospital was
REQUIRING me to pay $13,500 upfront before I set for in the hospital. THIS
WAS VERY DISCOURAGING. I switched surgeons and found a WONDERFUL man who
talked to the hospital and got the fee waived. He also didn't require me to
pay his fee upfront either. Incidentally, this surgery is a COVERED benefit
and that is why FEP BCBS doesn't preauthorize. They will pre-certify but
that doesn't mean anything to the hospital or doctors. If you meet their
requirements then you should be fine. I'll find out soon I guess. I only
have aches/pains as a co-morbidity and am 100-lbs overweight. FEP BCBS
doesn't preauthorize ANY surgery. I just had a hysterectomy in June and
they paid out wonderfully. All I am paying when I go for my WLS is $100 for
the hospital...I've met my deductibles for the year and that is why I was
wanting the surgery before the end of the year because I had paid it in.
Feel free to contact me if you'd like.
— Debra L. H.
November 29, 2002
The Federal BCBC Plan (especially of Georgia), can be discouraging. Almost
make you hate working for the government entity. I was soo excited when I
found out BCBS of GA paid for this surgery (providing you have ALL of the
requested information, etc). Had LAP RNY-proximal on 9/3/02,~my total bill
for the hospital was $34,000+, the total for my surgeons was 17,000+ ...I
don't have all of the particulars with me right now, but email me, and I'll
give you all of this information. I think one of the reasons I had such I
high bill for all concerned is because I went out of network and had some
complications (not related to the WLS). I was not at all pleased...I knew
that I would have to deal with a good portion of my bill, but NEVER
expected that I would end up paying $21,000 (and that's just for the
hospital, we haven't even totalled the other parts yet, mind you). We
(federal employees) pay 3 arms and 5 legs per month for this supposed
*excellent coverage*, only to be left with monumental medical bills...I am
going to try to work out a payment plan, but if they don't settle for that,
then bankruptcy may be another option. I feel better physically, and I may
just have to get a second job to take care of this obligation~we're doing
the best we can right now...my DH is working 2 full-time jobs.
Precertification is not required anymore, but be safe and check anyway.
They can be so wishy-washy and different customer service representatives
will tell you different things. There is a whole list of things I had
prepared before I even thought about Federal BCBS insurance. I researched
the WLS for about 3 years and wanted to make sure I had all of my duck in a
row-yeah, they approved me, but didn't pay enough as far as I'm concerned.
If you can DO NOT go out of the network for the surgeon, you will have to
pay more. I only chose to go out of the network because I chose Dr. J.K.
Champion. To me, no one can compare with his expertise. Don't regret going
to him AT ALL-my displeasure is with my insurance plan. Someone from BCBS
told me what to do next with regard to the large amount that wasn't paid
and I'll be taking some necessary steps within the next month or so. Don't
just stop at being at least 100 lbs overweight, there's more to it than
that...Remind me to tell you~~Sincerely, "Yourdivaness"
— yourdivaness
November 29, 2002
I have BCBS Federal and had open RNY 9-10-02. I followed their rules for
pre-certification and had no problems. Call them and they will tell you
exactly what you need. They paid for all pre-tests including the pysch
exam. Took about three weeks and they sent a letter of approval for
in-patient surgery. Am currently down 52 lbs. Yeah!
— Mimi R.
November 29, 2002
Hadiyah - your insurance plans - as well as all insurance plans - spell out
what the financial penalties (in the form of increased subscriber
obligations) are incurred by going to an out-of-network doctor. And, as
you say, it was your choice to go to an out-of-network doctor. To rip
your insurance company for following the guidelines which you were fully
aware of is uncalled for.
<p>
I went to an excellent bariatric surgeon & hospital who accepted my
insurance (Aetna US Healthcare) - all I had to pay was $200 for my
nutritional consult, $200 for my psych consult and $10 for my co-pay for my
initial consult with the surgeon. Starting with my 6 month visit in
January and subsequent follow-up visits with my surgeon, I will also have
to pay a $15 co-pay (AetnaUSHC is bumping up our specialists' co-pay $5
starting in January 2003).
<p>
So, for any pre-ops out there who are choosing to go out-of-network for
your surgeon and/or hospital, please review your medical insurance benefits
book to find out exactly what you are obligated to pay for this choice
before you find yourself tens of thousands of dollars in debt. If you can
find an in-network surgeon and hospital that you feel comfortable with, so
much the better. WLS does not necessarily have to mean financial
ruin...JR
— John Rushton
November 29, 2002
You have a lot of different responses to this and I am wondering if all
federal bc/bs is the same. I have federal Carefirst bc/bs and I'm in the
Washington, DC metro area. My plan book says the same as you do. They
will pay if the person is at least 100 pounds overweight. My insurance
still does not preapprove anything which is has become a bit problemsome
with finding a doctor to do plastic surgery on me, but I had no problems
with my weight loss surgeon doctor because they were familiar with that
insurance. I didn't do anything and the doctor's office didn't do anything
but submit everything to them after my surgery. They paid.
— Lisa N M.
November 30, 2002
I have BCBS Fed PPO and had surgery 7/5/02. They did not pre-approve as
everyone is mentioning here. I had to pay the 10% co-pay to the surgeon
before surgery but nothing else to anyone else (except $15 office visits,
etc.). All bills have now been submitted and paid. The only problem areas
were that I had to call on almost every bill submitted and ask that it be
resubmitted. They denied the hosptial bill, surgeon's bill, anesthesia
bill, pathology, etc. the first time through. However, none had to be
"appealed" per say, they just sent them back through and all have
now been paid. The only other problem I have is that BCBS refuses
(apparently) to pay for LAP procedure, will only pay the OPEN rate.
Difference in my case is $8000. Surgeon's office told me they would not
bill me for the difference and my EOB shows I'm not responsible for the
difference in billed amount and negotiated savings. However, I just
received a bill from the surgeon for $7300+. Haven't decided how to handle
that yet, but I'm not planning on paying it.....
— jutymo
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