BLUE CROSS BLUE SHIELD FEDERAL

 I have Blue Cross Blue Shield Federal insurance and I wanted to know if anyone with that insurance has ever gotten approved for this procedure, the Sleeve. Time is winding down slowly but surely and I’m terrified that I’ll be denied coverage. Everyone in my position so far has been denied and at this point, I’m expecting it. Any advice would be greatly appreciated.

 

 

 

Federal Employee Program Blue Cross/Blue Shield Standard Option did begin covering VSG (they had already been covering for RNY and LapBand) as of 1-1-08 for those with BMI of 40 or >, or BMI of 35 or > with 2 co-morbid conditions. However, they only recognize certain co-morbid conditions.  I'm not sure about Basic Option.   Good Luck!   Shelly

 REALLY!? THANKS!!!!!! That will have me smiling for the rest of the day! (I have PPO by the way). I don't know what that is or if that means anything, but thanks again!

Basic option approved me!

Yep, we have PPO, too. Although you can use physicians out of network, the PPO options save $. Go the the FEP BLUE website and you can download a benefits booklet. Look at page 46, I think. ; ) Also, the only qualifying co-morbid conditions I have been able to get them to verify are diabetes, high cholesterol, and high blood pressure. However, I'm not 100% certain that these are all of them. Shelly

Hi Harris, Did you actualy contact BCBS Fed and gave them the code for VSG and they said they cover it? I seen on page 46 they covered gastric restrictive, gastric restictive with malabsorption and gastric malabsoptive procedure.  Now I'm not sure but someone told me the sleeve is call gastric restrictive procedure other than the Lap Band.  What you think? I just hope they have added this. I will be submitting my paper work next week, I sure pray for us all. Just let me know! Sylvia

Yes,, I contacted them and they verified it by phone. I did have the CPT code and had it verified that way, as well. As of 1-1-08 they started covering VSG, as well as RNY and LapBand. I also contacted an insurance coordinator specialist in FL and she confirmed that they have had several patients VSG's covered by Federal Employee Program BCBS. They do not do a preapproval process. You just have the surgery and then the claims are submitted and paid. Just remember that if your BMI isn't 40, or greater, that you need 2 co-morbid conditions and a BMI of at least 35. They would only verify diabetes, high blood pressure, and high cholesterol as qualifying co-morbid conditions when I spoke to them by phone.  Best Wishes!!!     Shelly

I have BC/BS federal and I had my surgery Monday.  I did have high blood pressure, diabetes, and sleep apnea.  I was approved quickly and did not have a waiting period.  Best of Luck!

Well, thank you and THANK YOU........thats GOOD NEWS! I believe I'll get my dance on....... Good luck on you Journey!! Sylvia

Hi there, my name is Kris.  I have the BC/BS Federal Insurance.  I work for US Border Patrol. I was approved first for the RNY procedure.  At first that is what I thought I wanted.  After being approved for that/on the same day, I decided VSG.  One phone call from my Dr. office to Insurance co. and was approved for VSG instead of RNY.  Love Fed Insurance!!!!!!  My procedure was on Dec. 5, 2007.  I have lost total of 89 lbs.  15 pre-op.  I LOVE MY VSG!!!!!!