Question:
Does anyone have Federal Blue Cross/Blue Shield?
My insurance carrier is Blue Cross for Federal Employees. As of January 1, 2001, they are no longer doing pre-determinations for WLS. You are supposed to have the surgery and then they decide if they will pay. Has anyone with this insurance had WLS this year? If so, did BC pay for the surgery? I've found two people so far -- in one case they paid, in another they didn't. I've read my policy and I think I should be covered, but I hate to take a $20, 000 gamble. Any info would be appreciated! — Denise C. (posted on July 1, 2001)
July 1, 2001
hi denise. i have fed bc & i called them to ask if wls is covered. i
was told 'the surgical treatment of obesity is not covered'. my next
question was 'well what do i do about all my medical conditions &
failing health?' her answer was a real kicker! 'oh we will cover all ur
medical conditions because they r medical conditions covered by ur
contract.' duh! so i rummaged around & found my good old bc book &
looked thru until i came to the page where there is a tiny little blurb
that says wls IS covered for the person who is 100 or more pounds
overweight. so back to the phone i went hoping to get a more informed
customer service rep. i did & her answer was the same as the book's. i
then asked if i need preapproval. the answer was no but we do have that 48
hour time limit of letting bc know we r being admitted to the hospital for
surgery. my next question was if i was limited to the kind of surgery (rny
or lap). the answer to that was 'thats between u & ur dr. good luck to
u.' I have an appt with dr mal fobi on july 6. my forms show my insurance
coverage & his office made my appt so i assumed that he has no problem
with fed bc. i then went to the surgeons info page & found that on
march 21, 2001 he was paid by fed bc for someones surgery. so, i am going
on the theory that if they just paid the dr 3 months ago there wont be any
problem for me. i assume the same will hold true for u. also, when i
attended a support meeting 2 weeks ago, i met 2 women with fed bc &
they said not only did bc pay...it didnt cost them one cent out of pocket.
good luck!
— sheryl titone
July 1, 2001
Hi Denise, I too have BC/BS Federal and I had my surgery on 02/21/2001, on
my page, it have listed everything bc/bs paid for me.
— s r B.
July 1, 2001
BC/BS Federal DOES cover WLS, it says so in the book as long as you qualify
under their standards, which someone posted. Look in your provider book or
www.fep.org (or com?) They don't precertify for _any_ surgery any more,
you do get a letter of authorization to pay for your hospital stay, though.
All federal plans _must_ cover WLS, as well as psychiatric, substance
abuse, etc.
— M. A. B.
July 1, 2001
I have BC/BS FEP and it covered my Open VBG....
AND - someone here said they don't pre-certify any surgery anymore. Not
true - I got my Pre-Certification letter a month before my surgery date,
stating the days I was certified for, how many days, etc...And, my husband
had knee surgery in April, he got Pre-Certified for that as well.
— Cathy J.
July 4, 2001
I had RNY gastric bypass on April 26th of this year. The insurance paid
for everything except my nutritional class ($50.00). I only owed the
hospital $100.00 for my deductible and my surgeon was totally paid for.
Some of the bills are still coming in but it appears they are all being
covered as well. I was very pleased.
— Shellie G.
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