Jump to content
×
Are you looking for the BariatricPal Store? Go now!

federal employee program BCBS



Recommended Posts

I have federal BCBS...as does my mom...we were both approved within 6 weeks from the psych eval being sent in....keep at it!

Good luck!

Share this post


Link to post
Share on other sites

I also pointed out that the in 1991 the National Institutes of Health wrote a Consensus on Gastrointestinal Surgery for Severe Obesity that did not include a 6 month requirement for candidates for surgery.

Do an internet search for the document and include it with your appeal. But it sounds to me like you already have the diet aspect covered.

What a pain in the patootey!

Thanks for the article (and supprt) Cocoabean...

and I just noticed you are about a sneeze away from your (and my) goal weight! CONGRATS! I'm hoping my doctor/medical group (Greater Newport Physicians) agrees with you.

How did you go about choosing a surgeon? My doc put a specific name on the referral (and seems very reputable), but I'd still like to have some control in the choice, even If i do choose the same dude.

Share this post


Link to post
Share on other sites

I went with my PCP's choice. He said he was who he would choose for himself. In fact, he did about a year after my surgery he had gastric bypass done by my surgeon. I'd hope your PCP would be open to referring you elsewhere if you do not like his first choice. I had a choice of two in my HMO, but liked my PCP's first choice so well I stuck with him.

I went to my surgeon's info seminar before my appeal was done. His are free. My hubby came with me. We both really liked him, so I was very happy when I won the appeal!

It sounds like you have all your ducks in a row. I also mentioned in my letter that I want the surgery so that I can have a relatively normal life, and take part in daily activities with my family. I spoke about how obesity affects the quality of my life and limits my activities.

The package I submitted was probably 15-20 pages. It was a lot of work to put together, but very worth the effort!

Keep us posted!!!!

Share this post


Link to post
Share on other sites

I have BCBS Federal Basic, I was told that a BMI or 40 or greater or 35 or greater with two co-morbid conditions are the only requirements, no supervised diet..the only other criteria are the ones set forth by the NIH (which include the psych Eval.)...I called them last week...Looks like I will only be paying $100 per surgeon in copays and $150 per day at the hospital up to $750 and of course the normal copays for all of the pre-op and post-op doctor visits...which is way less than paying for diabetes or heart disease later in life!! Hoping to get my approval in JUNE, wish me luck!

Share this post


Link to post
Share on other sites

It's not quite the same but I got a denial for lap band removal (mine slipped) within 5 days. I appealed and it took 9 months for them to approve removing the band. Then it's been another 7 months since I appealed to Washington DC for a revision. Appeals are supposed to be closed within 60 days. So in my experience they've been super fast on the denials and criminally negligent on the appeals.

Britt

Share this post


Link to post
Share on other sites

Does anyone have any experience with Sentara Norfolk General and FED BCBS of VA? I am right at a BMI of 40 with no known co-morbidities.

Share this post


Link to post
Share on other sites

You should be just fine. I've been fighting the OPM for many months over a revision. In what they've written to me it's pretty much a done deal with a BMI 40+. They've even indicated if I gain to 40 they'll change their minds bout my revision (grrr).

I don't think you'll have any problems at all.

Britt

Share this post


Link to post
Share on other sites

I guess what I am concerned with is do they require your BMI to be OVER 40, ie 41. Because I told Sentara at my seminar that I was 233 (which was the last time I weighed myself) AND that is a BMI of 40 but they told me that my weight was not enough unless I had two co-morbidites.

I actually went home and weighed myself with clothes on and I was 241 that night. When I called to schedule my 1st consult I revised my weight with them. They said that was better, a BMI of 41. Well now, I have weighed myself nude and I am 238, BMI 40 again. So, I am litterally trying to gain lbs to make sure I am over BMI of 40 when I go in there on JUNE 1 for my first consult.

blah..I am so frustrated...

Share this post


Link to post
Share on other sites

Mine states greater than 40 or 35 to 40 with 2 comorbidities. Your plan brochure should be pretty straightforward.

Insurance Programs has the plan brochures for 2010.

Share this post


Link to post
Share on other sites

Now that i read mine tat is what it says. Just a question do they weigh you with or without your clothes on??

Share this post


Link to post
Share on other sites

My surgeon weighs with clothes on, but shoes off. I have read of some who take weights with the patient in a gown. Make your appointment later in the day, you will be heavier. Wear jeans and a sweater, too, if you are allowed to weigh in clothes, might as well go for it!

Best wishes!

Share this post


Link to post
Share on other sites

I also have federal bcbs and have heard different info regarding the waiting period. What is the waiting period, not seeing one in the book?? I have basic coverage. I went into the seminar today and they just had us write down our weight, height and bmi. Said they would call in a week or so and let us know if our insurance would cover it. Was shocked they didn't weigh us. I am wondering once they call and say if approved what the next step is. Have heard there is a 3 month, 6 month and no wait. Hoping to hear I am approved, not sure where to turn next if not. :tongue2: Love reading all of the insights and information on this site~ so informative!

Share this post


Link to post
Share on other sites

Hi. I have the BCBS FEDERAL Basic plan..which is the best in coverage. Basically covers 100 percent. I have been to the seminar, met with my surgeon, just had my psych eval nutritionist and physical all in one day at the surgns office. From everything i ready, they do not require a sup diet. if you are above 40 bmi then they do not require one. I am only a 37 and it says nothing in the brochure about a sup diet just that you have to have comorbities.. A lady from my surg office called after my initial appt and told me that I have to do a 3 month sup weight loss. I was very surprised but i went ahead and started it anyway. which i am in the middle of. So last week i got another call from their office and they said that it looked like i have met all the requirements and the lady i spoke to before made a mistake and i didnt need a 3 month diet. So yesterday is when i did all the preop stuff(psych, nut, phys) and they told me it would take a few weeks to get all that info compiled into a letter for insuraance and i should hopefully hear something within 3 weeks if im approved. What i have heard from others and i have checked ALOt believe me,,,is that BCBS FEDERAl (FEPBLUE) is super fast in there approvals. some people have told me they got approved in 2-3 days. Lemee know if this helps...i am super excited and ready for this journey..sounds like we are kinda in the same boat! Good luck with everything!:Dancing_biggrin:

Share this post


Link to post
Share on other sites

I have the same fed bcbs basic, no co moribs, bmi was 40 was apprvd in three weeks aftr surgeon submitted paper work..surgery was 5~14..

Share this post


Link to post
Share on other sites

I was wondering, with FED BCBS Basic, do you have to pay an extra fee for fills? Or is it just considered a normal copay?

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • vsg.with.sharon

      Hey everyone!
      I’m new here! Looking for some friends! 🥰
      · 0 replies
      1. This update has no replies.
    • LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×