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Topic: Changes to FEP BCBS for 2011
I posted this on the VSG forum. But thought this would also be helpful to put on the insurance forum.
Hello VSGers...
If you are a Fed employee it is open enrollment time.
Well I currently have FEP BCBS and began my process in August to consider surgery for early 2011. Well since it is open enrollment, I wanted to review the changes to the plan (of course I am mainly interested in the changes regarding WLS and some others).
Well there are some changes, mainly they are requiring a 3-month participation in a medically supervised weight loss program, including nutritional counseling begining in January 2011
So those that are looking to have surgery early next year, please be advised of the new requirements. They can be found on page 53 of the Blue Cross Blue Shield Services Benefit Plan. Go to your HR office or find it on-line at www.fepblue.org.
Just thought I would share...
If you have additional information please share with other FEB BCBS VSGers.
Have a good day!
Hello VSGers...
If you are a Fed employee it is open enrollment time.
Well I currently have FEP BCBS and began my process in August to consider surgery for early 2011. Well since it is open enrollment, I wanted to review the changes to the plan (of course I am mainly interested in the changes regarding WLS and some others).
Well there are some changes, mainly they are requiring a 3-month participation in a medically supervised weight loss program, including nutritional counseling begining in January 2011
So those that are looking to have surgery early next year, please be advised of the new requirements. They can be found on page 53 of the Blue Cross Blue Shield Services Benefit Plan. Go to your HR office or find it on-line at www.fepblue.org.
Just thought I would share...
If you have additional information please share with other FEB BCBS VSGers.
Have a good day!
Topic: Aetna- pre cert vs approval? confused
When I got my insurance letter about the reversal of my my denial, it sad that the surgery still had to be precertified by calling the number on my card. do I do this or does the surgeons office? now I am a little confused!
Topic: RE: Got a referral from my PCP for Surgery. Does this mean I am approved?
The fact that your PCP has provided a referral is a good thing -- that means the PCP supports the idea.
The surgeon will need to submit for final approval from the insurance company and most likely will need to obtain some history from your PCP.
Good luck.....
The surgeon will need to submit for final approval from the insurance company and most likely will need to obtain some history from your PCP.
Good luck.....
Topic: RE: Has anyone used Health Insurance Navigators for appeals
Sometimes they are hard to get ahold of bc they are so busy but keep trying! My process took forever. Not because of OL but because of insurance appeal and then my external appeal. It was worth the wait though. Why is your insurance denying you?
Duodenal Switch on February 21, 2011
Surgery weight: 276; Current weight: 122; Height: 5'5
Plastics scheduled for 10/3/14: BL/BA, LBL, TL
Topic: RE: Has anyone used Health Insurance Navigators for appeals
Thank you! I went to obesity law last week and filled out their form based on seeing another post of yours :) I got an auto reply and will try calling them this week... I'm happy to hear that they worked for you.
I am sending you lots of light for your usrgery next week
I am sending you lots of light for your usrgery next week
Peace and Love 
Lisey is my Angel
Lisey is my Angel
Topic: RE: Got a referral from my PCP for Surgery. Does this mean I am approved?
Probably not.. The Surgeoun will need to submit to the insurance company for approval.. It sounds like you have been through a lot..so it shouldn't be too bad.
Topic: RE: Has anyone used Health Insurance Navigators for appeals
I have never heard of them. For my appeal I used the Lindstroms and they were great. They helped me get approved for lap band removal to DS revision. They also have very reasonable rates and specialize in weight loss surgery insurance problems. Their website is www.obesitylaw.com. Good luck!
Duodenal Switch on February 21, 2011
Surgery weight: 276; Current weight: 122; Height: 5'5
Plastics scheduled for 10/3/14: BL/BA, LBL, TL
Topic: RE: Appeals -- Attorney help may be needed
Written reason is odd...... first they comment that band over bypass is experimental (not a proven procedure).... then they specifically state that my BMI is too low 37.5 ... however they go on to stte that they will also consider 35 with co morbidities, they also stated the application for approval did not contain 5 years of weight history.... Well, it contained almost 8 years!
I am still diabetic (on two types of injections and oral meds) still cholestrerol problems (back on simistatin) and still HBP (back on lisopril)....\
That said, the surgeon's office immediately prepared a cover letter stating all of the above.
SoI'm gathering info about attorneys just in case.
I am still diabetic (on two types of injections and oral meds) still cholestrerol problems (back on simistatin) and still HBP (back on lisopril)....\
That said, the surgeon's office immediately prepared a cover letter stating all of the above.
SoI'm gathering info about attorneys just in case.
Topic: RE: DS denied because of BMI under 50
There is good news and bad news:
I have BCBS of Illinois Blue Advantage HMO
The good news:
I was able to get approval for DS even though there is not a DS surgeon in network. First I was sent to a surgeon who does RNY who suggested that DS would be a better option for me. He wrote a letter to my PCP explaining that. Only after that did I get a referral for a consult with an out of netwok surgeon for DS. After jumping through a few more hoops, I just got my referral for surgery yesterday.
The bad news:
I have a BMI of 52. I imagine that if itwas lower, I would have been stuck with RNY.
I have BCBS of Illinois Blue Advantage HMO
The good news:
I was able to get approval for DS even though there is not a DS surgeon in network. First I was sent to a surgeon who does RNY who suggested that DS would be a better option for me. He wrote a letter to my PCP explaining that. Only after that did I get a referral for a consult with an out of netwok surgeon for DS. After jumping through a few more hoops, I just got my referral for surgery yesterday.
The bad news:
I have a BMI of 52. I imagine that if itwas lower, I would have been stuck with RNY.
Topic: Got a referral from my PCP for Surgery. Does this mean I am approved?
After several years of jumping through hoops, classes, multiple surgical consults, a battery of test, etc, I finally received a referral letter from my PCP for DS Surgery at University of Chicago.
Is this all I need? Does this mean I should be doing the happy dance and that my surgery is going to be covered? Did I finally reach the light at the end of the tunnel?
I have BCBC Illinois Blue Advantage HMO. My medical group is Hammond Clinic.
Thanks for any insight.
Is this all I need? Does this mean I should be doing the happy dance and that my surgery is going to be covered? Did I finally reach the light at the end of the tunnel?
I have BCBC Illinois Blue Advantage HMO. My medical group is Hammond Clinic.
Thanks for any insight.
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