Anyone have experience with BC/BS Federal Employees Plan?

I am just beginning research on WLS. Does anyone have experience with the Blue Cross Blue Shield Federal Employees Plan? Also, what's the best way to start researching WLS?

Hi!! I have BCBS fep also.  I have just started this WLS journey, so I don't know a lot....but I'll tell you what I have been told.  BCBSfep covers RNY and Lapband surgery, as well as some of the other variations.  You have to be over 18 years old, either have a BMI of greater than 35 with co-morbidities or have a BMI of greater than 40 without, you have to have been this BMI for 4 of the last 5 years, and you have to go through all the testing and pre-op screeening.  I confess I'm worried about the 4 out of 5 years criteria.  I have certainly been this large for that long, well over 10 years in fact, but I haven't been to the doctor regularly to record my weight and height.  The insurance company wants 4 or 5 years of weight/ heights from your doctor's files.  I am hoping to be able to send in dated pictures to prove my weight.  Some others on this board have said they were able to get BCBSfep to cover the surgery with pictures.  On the posititve side, this does appear to be one of the easier insurance companies to deal with.  Just talk to your doctor's office.  They have the most experience handling this end of the surgery,

Thanks for the information. It is a relief to hear that this plan does cover various types of the surgery. Do you know if they restrict which physicians/facilities you can go to? Also, do they require the six month period of diet beforehand? As I said, I am just starting out. My BMI is about 45 and fortunately, I don't have alot of health problems related to my being overweight (yet). This is one of the reasons I think I may be a good surgical candidate.  I too have been heavy for a long time - at least 20 years. By the way, I work for the VA system. Where do you work? Rose

Well, I have Standard BCBSfep, so I can go anywhere, but they pay more of the bill to PPO doctors, of course.  I think with Basic BCBSfep, you have certain doctors that are within your network, and you have to go to one of those doctors to be covered.  The bright side is that with Basic it appears you will have little if any out of pocket expenses.  With Standard, you have to pay a 10% deductible on the allowable charges.  I know it sounds like a lot, but everyone has been telling me that it ends up being less than $300-$400.  Hopefully that is true.  Federal BCBS does not require a six or three or any month diet plan.  There are some state BCBS programs that do require the six month diet, as well as some private BCBS programs do.  I called them myself and asked about this and was told there is no six month diet requirement.  Anyway, I hope it works out for you.  Let me know how it goes.  I work for the Postal Service and boy, it would be nice to be able to carry that mail with less of me to carry!! Take care!

I also have the Blue Cross Blue Shield Federal Employees Plan. I am beginning to research WLS. I was wondering the same thing. Good luck on your journey.

Thanks for your reply. I have heard that this plan is one of the easier plans to work with and it covers a variety of WLS procedures. Good luck on your search. Rose

I have Federal BC through the VA.  I was told by them to go to BCBSTX.com to review their policy

http://medicalpolicy.hcsc.net/medpolicies/home?corpEntCd=IL1 &path=templatedata\medpolicies\surg\data\SUR716.003A_2006-12 -01&ctype=MEDPOLICIES-POLICY&cat=SURGERY#hlink

I have to have a 5 year documentation of obesity and a 6-month diet history (within the past 24 months).  I was also told that they do not pre-approve this surgery, but review it when the bills are submitted and per the letter I received from BC, "Claims are reviewed for medical necessity upon receipt and any benefit determination will be based on the information received".  I don't know how they get away with this, but it is a pretty scary prospect that they get to determine eligiblity AFTER the surgery is already completed. I was also planning on having the sleeve procedure, but the policy states, "Sleeve gastrectomy, when done as the sole procedure, is considered experimental, investigational and unproven as a treatment for morbid obesity." I only have to have my psych profile (once I find a pscyhologist or psychiatrist who takes BC and will do a pre-op eval) and will be ready to schedule surgery, but am more anxious about the insurance than the surgery itself.  Has anyone dealt with any of these issues?  Thanks

I have BCBSfed also, so I will be following along to see how all of you do with it!  From what I've read in my benefits guide, it looks like it is all covered except for a few hundred dollars.  When I get more info, I will share it here.  :)

I went to my consultation yesterday.  I took my weight documentation I had managed to scrape together (2003 Dr. visit, a 2004 Weigh****chers card, and some old Dr. visits weight records from 1995-2000), my paperwork they gave me at the seminar, and pictures from the past 6 years.  The insurance lady did not think I would have a problem getting approved even though I don't have my weight documented for the last 5 years.  We'll see.  I hate to get my hopes up.  The only thing I need to do is have a psych evaluation, a meeting with the nutritionist, and a thyroid panel.  They said I didn't have to do a six or three month diet, and after they send this packet in and get approval, I have to have an ultrasound on my legs and some other bloodwork done before surgery.  The consultation went well.  I almost died when I stepped on the scale and saw how much I weighed!!!  The doctor was informative and said we could do the RNY laproscopically, which was another concern of mine.  Anyway, they have set up my appointments for the required pre-op screenings and I'll let you know if BCBSfep approves me!  Keep your fingers crossed!!

My fingers are crossed for you!