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FED BCBS

crystal w

By crystal w, in Insurance & Financing

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crystal w    0

crystal w
Posted

Hi everyone,

I'm trying to find anyone that has this insurance that completed the required 3 months supervised diet and gained during that time. I was wondering if your surgeon's office submitted anyway and if you got approved. If it was denied, did you have to do another 3 months during the appeal?

I'm looking to revise from band to sleeve. When I started this I was 233 and 244 at my last weigh in on Mon apr 4. On wed the 6th I put myself on an all liquid diet and I'm down to between 235 and 236. I want to call the bariatric nurse tomorrow and ask her to schedule another weigh in for me and then submit

Do you think I should lose a lot more before I try?

Thanks for any suggestions/advice

Crystal

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StacyS    20

StacyS
Posted

I have BCBS-Fed and just completed my 3 month yesterday!!!! My BMI was right at 41 so I couldn't afford to lose any weight during the 3 months. I lost 2 lbs the first month and then gained 3 by the last month. It really depends on your BMI.... if you are way over 40 then I would recommend attempting to lose weight. If you are not, then DO NOT lose any weight!! Insurance will not approve you if you are not 40 BMI. I am currently waiting for the word from Dr's office on whether I'm approved or not. They submitted to insurance yesterday, so I should know before the end of the week. I'll keep you updated

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crystal w    0

crystal w
Posted

I have BCBS-Fed and just completed my 3 month yesterday!!!! My BMI was right at 41 so I couldn't afford to lose any weight during the 3 months. I lost 2 lbs the first month and then gained 3 by the last month. It really depends on your BMI.... if you are way over 40 then I would recommend attempting to lose weight. If you are not, then DO NOT lose any weight!! Insurance will not approve you if you are not 40 BMI. I am currently waiting for the word from Dr's office on whether I'm approved or not. They submitted to insurance yesterday, so I should know before the end of the week. I'll keep you updated

Thanks Stacy. Even if I got down to 229 my BMI will be 43.2 so I'm ok there. This morning I was 234. The nurse wants to show at least some loss from the initial weigh in. I'll be keeping my fingers crossed for both of us. And please do let me know what you find out from the ins co. Good luck!!!!!!!!!!!

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ashleyc    10

ashleyc
Posted

Ok so I have fepblue too. My first appt with pcp to start the 3 month diet was april 4th. does that mean that i have to wait all the way to july or can i be done in june????

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crystal w    0

crystal w
Posted

Ok so I have fepblue too. My first appt with pcp to start the 3 month diet was april 4th. does that mean that i have to wait all the way to july or can i be done in june????

You'll be done in June.

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StacyS    20

StacyS
Posted

It will be July, not June. April-May= month 1 May-June= month 2 and June-July= 3

I know because I thought mine would have been Jan-Mar but NO.... Jan thru April. It sucks but that's what they require.

BTW- I'm hoping today will be the day I get approval... They told me on Tues that it would be 24-48 hours and today = the 48 hours!! Please keep your fingers crossed for me!!!

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ashleyc    10

ashleyc
Posted

I was approved for surgery yesterday!!!! My date is 25 April... I'm so flippin excited!!!

That's awesome Stacy!!! You will be having surgery on my hubby's birthday!!! :)

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crystal w    0

crystal w
Posted

Sooo happy for you!!!! Good luck with everything. Here's to a smooth surgery, quick recovery and and complete success!!!

I was approved for surgery yesterday!!!! My date is 25 April... I'm so flippin excited!!!

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re7777    1

re7777
Posted

I have BCBS-Fed and just completed my 3 month yesterday!!!! My BMI was right at 41 so I couldn't afford to lose any weight during the 3 months. I lost 2 lbs the first month and then gained 3 by the last month. It really depends on your BMI.... if you are way over 40 then I would recommend attempting to lose weight. If you are not, then DO NOT lose any weight!! Insurance will not approve you if you are not 40 BMI. I am currently waiting for the word from Dr's office on whether I'm approved or not. They submitted to insurance yesterday, so I should know before the end of the week. I'll keep you updated

That's great news! I have Federal BCBS and my bariatric coordinator mistakenly submitted me for the bypass instead of the sleeve. I got approved for the bypass on Tuesday, but am now waiting to hear whether they'll approve me for the sleeve. No idea how they messed up like that, but the fact that you were approved for the sleeve gives me hope. We scheduled a date for 5/24, assuming that fepblue won't give me a problem about the sleeve and will approve me just as quickly. Good luck!

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AKMama    36

AKMama
Posted

So why is that some BCBS Fed will cover the Sleeve and some will not.

Lara

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StacyS    20

StacyS
Posted

Do you have FEP Blue? AKA Fed-BCBS? I dont think it really matters but on their website they list Bariatric Surgery. It doesnt specify which surgery they cover and which ones are excluded but I would call the number on the back of your card and see if they do! I think it's the BCBS of different states that dont cover the sleeve. I know for sure FEP Blue does cuz they approved me!

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re7777    1

re7777
Posted

I remember reading past posts on here that it's the state administrators of the federal bcbs plan that make the call. However, most of those posts were before December 2010. The 2011 plan brochure (p. 52) states that they cover the following:

Gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures

The sleeve is a gastric resstrictive procedure, which means that it is covered. If I recall, this language is different than the language in the 2010 plan brochure.

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AKMama    36

AKMama
Posted

I remember reading past posts on here that it's the state administrators of the federal bcbs plan that make the call. However, most of those posts were before December 2010. The 2011 plan brochure (p. 52) states that they cover the following:

Gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures

The sleeve is a gastric resstrictive procedure, which means that it is covered. If I recall, this language is different than the language in the 2010 plan brochure.

Well, this sounds promising. I will have to chewck it out. Thanks for the information!!

Lara

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Go To Topic Listing Insurance & Financing

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