Anyone With Bcbs Fed?

[ko22 1]

Did you have to pay your copay at the hospital prior to surgery or did the hospital bill you?

I had to pay the dr and drs assistant each $150 then pay $75 for out patient surgery all before

[NDN_RN 527]

I had to pay the dr and drs assistant each 150 then pay 75 for out patient surgery all before

Outpatient? lucky. I have to stay in 2 days, that's 300.. Also basic states only one 150 copay to surgeon, everyone else is covered

[NDN_RN 527]

Oh yeah, seems everyone wants their co-pays ahead of time. Hospital bills, because they want to make sure of the reimbursement, and stuff happens which could prolong your stay.

[besquared1426 49]

Well, lucky me I guess. I just met the 5 grand oop so I no longer have to worry about my co-pay for WLS. Thank goodness I have an FSA.

[NDN_RN 527]

Well' date=' lucky me I guess. I just met the 5 grand oop so I no longer have to worry about my co-pay for WLS. Thank goodness I have an FSA.[/quote']

Ouch! On fed bcbs? I sont have those kinds of co pays i think. I have basic plan and it seems ro pay so much more. Only thing is you have to use Prefered providers. Its hard not to find one.

[SleeveandRNYchica 1,155]

The medically supervised program for at least 3 months prior and nutritional counseling regarding pre/post op nutrition. They are two different things from what I am gathering. I am not sure if for Federal State requirements are considered.

I took this out of the benefits book:

Note: Prior approval is required for outpatient surgery

for morbid obesity. For more information about prior

approval, please refer to page 15.

• Benefits for the surgical treatment of morbid obesity,

performed on an inpatient or outpatient basis, are subject

to the pre-surgical requirements listed below. The

member must meet all requirements.

− Diagnosis of morbid obesity (as defined on page 53) for

a period of 2 years prior to surgery

− Participation in a medically supervised weight loss

program, including nutritional counseling, for at least 3

months prior to the date of surgery. (Note: Benefits are

not available for commercial weight loss programs; see

page 35 for our coverage of nutritional counseling

services.)

− Pre-operative nutritional assessment and nutritional

counseling about pre- and post-operative nutrition,

eating, and exercise

− Evidence that attempts at weight loss in the 1 year

period prior to surgery have been ineffective

− Psychological clearance of the member’s ability to

understand and adhere to the pre- and post-operative

program, based on a psychological assessment

performed by a licensed professional mental health

practitioner (see page 86 for our payment levels for

mental health services)

− Member has not smoked in the 6 months prior to

surgery

− Member has not been treated for substance abuse for 1

year prior to surgery and there is no evidence of

substance abuse during the 1-year period prior to

surgery

[NDN_RN 527]

I am certain the federal employee bcbs plan req are different. They require 3 monthly nut visits one psych eval and a letter of medical necessity from your PMD. You must have a bMI of 40, or a BMI of 35 with one comorbidity such as diabetes hypertension sleep apnea or hyperlipidemia.

[SleeveandRNYchica 1,155]

They may be different from the State requirements, but I went on FEPBLUE and I would think all FED employees follow that or does each Agency do something different?

[NDN_RN 527]

Maybe. I dont think so. The requirements were triple checked with 3 different costumer service representatives by my surgeons patient advocate, me, and my primary MDs office. Also, my surgeons office has done several sleeves on federal BCBS patients and the requirements were the same.

[kimmyiet 40]

Hey ladies...

If you ladies go on www.fepblue.org and then click on the Benefits + Services tab, you will see a pdf format of the benefits booklet, that is across the board for all federal employees. The benefits refer to the Basic and Standard plan.. I hope this helps..

[NDN_RN 527]

Hey ladies...

If you ladies go on www.fepblue.org and then click on the Benefits + Services tab' date=' you will see a pdf format of the benefits booklet, that is across the board for all federal employees. The benefits refer to the Basic and Standard plan.. I hope this helps.. [/quote']

Thanks Kimmyjet. I looked at it and it was all covered in my letter of medical necessity by my Primary MD and the psych eval. I am seeing my nut ( out of pocket) for 3 visits. The patient advocate is confident it will all go through. They seem to know how to get the job done.

[kimmyiet 40]

Thanks Kimmyjet. I looked at it and it was all covered in my letter of medical necessity by my Primary MD and the psych eval. I am seeing my nut ( out of pocket) for 3 visits. The patient advocate is confident it will all go through. They seem to know how to get the job done.

You are welcome! I completed all the requirements from both insurance and surgeon office on June 21 and my paperwork was submitted to FedBCBS on June 25, they approved my surgery on June 29th. My nuts visits where not with a preferred provider she was a participating provider and my doctor's office wrote off all visits. Actually with surgeon I’m seeing I've only paid one time which was my initial visit and my psych visit cost me $35.00, so far I have came out on top.

[NDN_RN 527]

You are welcome! I completed all the requirements from both insurance and surgeon office on June 21 and my paperwork was submitted to FedBCBS on June 25' date=' they approved my surgery on June 29th. My nuts visits where not with a preferred provider she was a participating provider and my doctor's office wrote off all visits. Actually with surgeon I’m seeing I've only paid one time which was my initial visit and my psych visit cost me 35.00, so far I have came out on top. [/quote']

Great! Do you have a date?

[kimmyiet 40]

Great! Do you have a date?

Yep! Aug 30th...I'm so looking forward to it..

[NDN_RN 527]

Good luck!