How long for an OPM appeal review?

Hollyhock
on 3/23/11 10:20 pm - VA
I have the BCBS Federal Employee Plan, administered by Carefirst.  They have denied me twice for coverage of a VSG, and I'm just about to submit an appeal to the Office of Personnel Management, who oversees the FEP.

Anybody out there done an OPM appeal?  How long did it take to hear back?  They have a 60day window, but I'm hoping it'll be much shorter than that.  I am very anxious to wrap up this appeal process as soon as possible.  I started this BS in October 2010.
5'7"  VSG on 6/6/2011  HW 224, SW 214, CW 144  
B. Bap
on 3/24/11 6:20 am
OH NO!!!!
I am so sorry to hear this. You know I do not know this answer, but I hope some one is able to provide answer for you.  The insurance forum isn't as active as this one, but maybe some one has some input there.

What was the reason they gave you for this second denial?

Please keep me posted.  You know that I understand your frustration with Carefirst.

B.Bap
emelar
on 3/24/11 6:32 am - TX
I'm baffled by their refusal.  I have BCBC-FEP and they didn't even blink in approving the VSG.  The benefits booklet states that they cover:

Gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures to treat morbid obesity – a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with co-morbidities who has failed conservative treatment; eligible members must be age 18 or over.

To me, this covers the band, bypass and DS, as well as VSG.  And I know that there are others on the board that had their surgery covered by FEP.  FEP isn't suppose to have regional variances in coverage.

I feel your pain.  Don't know how long OPM would take to resolve this, but I'd plan for the worse.
Hollyhock
on 3/24/11 7:54 am - VA
Seems pretty clear,doesn't it?  Carefirst is evil.   The first denial was that the sleeve is only appropriate for persons with a BMI over 50.  The second denial is that my co-morbidities aren't serious enough.  Ha!  I just got my diagnosis of sleep apnea.  So I have hope that OPM will reverse them.
5'7"  VSG on 6/6/2011  HW 224, SW 214, CW 144  
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