Federal BCBS, anyone have them as well??

I will start from the top!
I called my insurance 2 different times and they said the DS was covered if my surgeon prefered this surgery for me. The both said just follow the policy. They sent me a packet on our policy that included Bariatric Surgery. It said that all bariatric surgeries restrictive and malabsortion are covered if: (i am using all short handed here since i will not print all of this it would be severaly long)
No drug abuse for at least a year
No smoking
BMI 40+ and/or BMI 35 + with comorbidities
2 years morbidly obese
5 years of being obese
3 month trial of a doctor supervised weight loss
Must be 18 years +
Evidence of attempted weight loss 1 year prior to surgery
Psychological Eval

I have all that documented and have met all criteria.

So my surgeons office called me up today and tell me they only cover DS when I am 50+ BMI. WHAT?! He said he got the first answer like I did when he first called but when he called again the lady took two hours to get back to him with this different guidelines. I have the policy right in front of me and it does not mention one thing about that, neither did the two reps I called. Something is fishy and I plan to find out tomarrow. I want to see this SO CALLED policy in writing and with the managers signature on it. Also I looked up BCBS Regence, which is the people handling the claim since I will be in Utah for surgery, and their policy says NOTHING about that either! lol
I will get them! lol No one is making me the the RNY! *stomps foot*


PS
Anyone have DS that was between 35 to 49 BMI that had Federal BCBS?
Let me know it could help me win this !

I have BCBS and they do have that requirement on the DS.  My DH and I found out today.   We will not even consider RNY either and I actually came here to post a thread inquireing about a VSG vs DS. 

I hate that insurance companies have so much control over us.  My DH's BMI is 44, but still "low" for the DS.  My DOCTOR will do the surgery, but the insurance will not cover it.

So we are stuck at the mercy of the insurance that we pay to serve us.

Sorry you are in the same position we are in.  Sucks.

(and just an FYI, I have the DS but had a BMI of 53)

This is a problem with the FEP plan.  The federal guidelines state what you've listed, then the state and/or regional BCBS that are contracted to provide services in an area interpret those guidelines seemingly however-the-hell-they-want.  Tell them to send you a denial in writing so you can start the appeals process with OPM.  Also tell them you want a copy of the FEDERAL medical policy that states you have to have a BMI 50+ to qualify.  Tell them it's not appropriate to apply standard Regence medical policy to you - you are FEP, and fall under different guidelines.  Document everthing each time you talk with them.  If you have to send mail, send it certified and require a signature - that way, it can't "get lost in the mail".

I have FEP, and started with a BMI of 41ish, and did not have problems qualifying.  I also chose to travel to a surgeon who was then in an area covered by a BCBS plan that correctly applied the federal guidelines to federal policyholders.  It was a huge issue though - I called the FEP customer service numbers for approximately 15 different areas, and got 15 different sets of requirements to qualify for surgery.  It still makes me mad when I think about it.  FEP policyholders all pay the same premium for (presumably) the same coverage, and yet we do not receive the same coverage, depending on where we seek services. 

My husband said the same thing. Thats our plan today is to call them up and have the Federal Policy sent to us in writing requiring those guidelines. Gosh! I get so frustrated with stupid Insurance mummbo jummbo. If they will screw you, they will gladly do it.

Don't be too surprised if they refuse to provide you a copy of the medical policy.  They may claim it's only for providers - if your surgeon is on board, have him/her request it and that way you can still have access to it.  I had several CSR's refuse to provide medical policies - they basically told I should submit, and see if it was approved or denied.  I didn't want to do that, in case it affected my ability to gain approval under a different BCBS umbrella.  Good luck.

To add to what I just posted:  what you're basically doing with the calls and requests is letting them know you will not go quietly into that good night.  Okay?  If they think they can make you go away without surgery, that's exactly what they'll do.

You have been a great help! I will not back down from this without a full out fight. I refuse to get the RNY, I am totally set on the DS. I know they don't have policy behind it becuase I HAVE THE POLICY in hand and it says nothing of the sort lol. So my husband and I are planning on putting a lovely Insurance Manager in the hot seat tonight! hehehe I will demand it in policy writing from the FEP BCBS plan and signed by their manager that this is legit. I refuse to have the RNY....

Thank you so much for your help. Also can I e-mail you as well if I run into any bumps?

You're welcome to email me anytime. 

It has been a couple of years since I went on my CSR calling spree - but I'll share everything I can remember.  Make sure of your requirements and read up on how to go about the OPM appeals process - that way when you say you're going to appeal, they know you mean business because you can quote the process to them.  

The next part is for anyone who might be reading our conversation, so please don't take it personally.

Please, don't just take my word (or anyone else's) as gospel about anything.  Independently verify everything you read.  I don't do that as much anymore, because I've now been around long enough to know who I can trust to provide good information.  There are a few out there, though, that disseminate 'information' that really scares me, especially regarding our supplementation needs.

I don't post much, but I am typically here every day, so I should see any message you send me in just a day or two.  There's always something new on the board to learn. 

I agree with you completely. I will go up to bat for myself and I will fight it out and get this done.
Also add me as your friend because, I can't seem to mail you otherwise... its being weird.

I have BCBS FEP, I had a BMI of 43.9 with no comorbidities.  I don't think I can help you though.  I didn't have to do a doctor supervised weight loss trial, and I don't think my PCP sent in the information of being obese for 5yrs.  Seems like things may have changed.  I live in New Mexico and my surgeon is in Texas, so they would have filled using Texas BCBS.

I was told when I called that there might be issues since I would be going out of state, but that I was allowed what my policy stated.

I wish you the good fight it is so worth it.

Betty