Federal BCBS paid for my sleeve 100%, minus the copayments for the hospital and my surgon!

[Miss Mac 6,261]

Retired from Federal service; My primary referred me to the Bariatric Program at the hospital. They established my program based on my coverage requirements and started me on a three month supervised diet. I had to provide two years worth of documentation that I had tried to lose weight on my own. My primary printed out a complete copy of his doctor's notes for the last two years. I went through with a highlighter and marked every place where my weight was measured or mentioned.

I also composed a letter detailing all of the different failed attempts with various well-known diets. In the letter, I also explained how my weight has affected my quality of life, my family history of morbid obesity, and how I expected the surgery to improve my health. Claim as many co-morbidities as you can. here is a list of conditions that the insurance companies consider

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease
• Family history of stroke
• Family history of diabetes
• Family history of heart attacks
• Hyperinsulinemia
• Diabetes
• High blood pressure
• Coronary-artery disease
• Hypertension
• Migraines or headaches directly related to obesity or cranial hypertension
• Congestive heart failure
• Neoplasia
• Dyslipidemia
• Anemia
• Gallbladder disease
• Osteoarthritis
• Degenerative arthritis
• Degenerative disc
• Degenerative joint disease
• Recommended joint replacement from specialist
• Accelerated degenerative joint disease
• Asthma
• Repeated pneumonia
• Repeated pleurisy
• Repeated bronchitis
• Lung restriction
• Gastroesophageal reflex (GERD)
• Excess facial & body hair (Hirsutism)
• Rashes
• Chronic skin infections
• Excess sweating
• Frequent yeast infections
• Urinary stress incontinence
• Menstrual irregularity
• Hormonal abnormalities
• Polycystic ovaries
• Infertility
• Carcinoma (breast, colon, uterine cancer)
• sleep apnea
• Pseudotumor cerebri
• Depression
• Psychological/sexual dysfunction
• Social discrimination
• Premature death in the immediate family
  

[fitdrea30 41]

Retired from Federal service; My primary referred me to the Bariatric Program at the hospital. They established my program based on my coverage requirements and started me on a three month supervised diet. I had to provide two years worth of documentation that I had tried to lose weight on my own. My primary printed out a complete copy of his doctor's notes for the last two years. I went through with a highlighter and marked every place where my weight was measured or mentioned.

I also composed a letter detailing all of the different failed attempts with various well-known diets. In the letter, I also explained how my weight has affected my quality of life, my family history of morbid obesity, and how I expected the surgery to improve my health. Claim as many co-morbidities as you can. here is a list of conditions that the insurance companies consider

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

Family history of heart disease

Family history of stroke

Family history of diabetes

Family history of heart attacks

Hyperinsulinemia

Diabetes

High blood pressure

Coronary-artery disease

Hypertension

Migraines or headaches directly related to obesity or cranial hypertension

Congestive heart failure

Neoplasia

Dyslipidemia

Anemia

Gallbladder disease

Osteoarthritis

Degenerative arthritis

Degenerative disc

Degenerative joint disease

Recommended joint replacement from specialist

Accelerated degenerative joint disease

Asthma

Repeated pneumonia

Repeated pleurisy

Repeated bronchitis

Lung restriction

Gastroesophageal reflex (GERD)

Excess facial & body hair (Hirsutism)

Rashes

Chronic skin infections

Excess sweating

Frequent yeast infections

Urinary stress incontinence

Menstrual irregularity

Hormonal abnormalities

Polycystic ovaries

Infertility

Carcinoma (breast, colon, uterine cancer)

sleep apnea

Pseudotumor cerebri

Depression

Psychological/sexual dysfunction

Social discrimination

Premature death in the immediate family

[HEARTonmySLEEVE2014 24]

On the FEP BCBS, did you wait for surgeon's office to contact you for setting up the 3 month of supervised weight lost program or how was that handled?

Also, what did you provide as evidence that attempts at weight loss 1 year prior to surgery was ineffective?

@@brians34 I actually had already begun a supervised weight loss program before I went in for my consultation with the surgeon. As far as my failed attempts, I just wrote a letter discussing my weight struggles and all failed attempts of weight loss, including fad diets and professionally supervised diets. I then just had my doctors office give me a copy of my paperwork from each visit I had over the past 2 years (to show my weight). One thing that I did not do and it yelled my approval up several days, was get documentation from my primary doctor, saying that I had not been treated for alcohol or substance abuse in the last year. Except for that minor delay, BCBS Federal was very quick with my approval. The surgeons office sent my info over on Thursday May 22, and I had a response Tuesday May 27. The 26th was a holiday, so it only took 2 Business days. I didn't get to fax in the missing documents until June 3 bc my primary doctors office took forever to get it to me..but I was officially approved on June 4!!

[brians34 31]

On the FEP BCBS, did you wait for surgeon's office to contact you for setting up the 3 month of supervised weight lost program or how was that handled?

Also, what did you provide as evidence that attempts at weight loss 1 year prior to surgery was ineffective?

@@brians34 I actually had already begun a supervised weight loss program before I went in for my consultation with the surgeon. As far as my failed attempts, I just wrote a letter discussing my weight struggles and all failed attempts of weight loss, including fad diets and professionally supervised diets. I then just had my doctors office give me a copy of my paperwork from each visit I had over the past 2 years (to show my weight). One thing that I did not do and it yelled my approval up several days, was get documentation from my primary doctor, saying that I had not been treated for alcohol or substance abuse in the last year. Except for that minor delay, BCBS Federal was very quick with my approval. The surgeons office sent my info over on Thursday May 22, and I had a response Tuesday May 27. The 26th was a holiday, so it only took 2 Business days. I didn't get to fax in the missing documents until June 3 bc my primary doctors office took forever to get it to me..but I was officially approved on June 4!!

Thanks SweeTEA

[Rovobay 920]

@Reviewer "I was sleeved in January, BCBS Federal covered 100% less $150 hospital and $150 surgeon co payments."

I hope that is my situation but from reading the service benefit plan it looks like Preferred: 15% of the Plan allowance (deductible applies) under the standard plan. do you have the basic plan?

[HEARTonmySLEEVE2014 24]

I have BCBS Federal-Basic plan

[AhnaLucille 57]

thanks for this thread. I've been a bit anxious about getting the sleeve and which insurance to go with. My current bcbs MI pays for almost everything I started the process in Oct. I found out my insurance is changing for 2015 and now need to pick fed BCBS basic or standard. . But from reading post around the internet. It sounds like I should pick basic for less out of pocket expense.

My PCP sent my letter out today! Next week I should hear from the surgeons office to set up my consultation. I can't wait!

I already did the psych evaluation. I've had 2 weigh ins but only 1 counts and my 3rd one next week (I need 6). But with the new insurance I'll only need 3 months of nutritional counseling. So I need to look into that.

Oh and it's mandatory by the surgeon to go to at least 2 support group meetings. I've missed the two available. So, I have to make Jan and Feb.. As long as everything runs smoothly and I do what I need to. I could have my surgery Mid-March.

So now, I tap my toes until I get the call

and thanks to everyone that posted here. Your information was helpful and eased my anxiety, a bit.

Edited December 5, 2014 by AhnaLucille

[kimdlawson06 141]

thanks for this thread. I've been a bit anxious about getting the sleeve and which insurance to go with. My current bcbs MI pays for almost everything I started the process in Oct. I found out my insurance is changing for 2015 and now need to pick fed BCBS basic or standard. . But from reading post around the internet. It sounds like I should pick basic for less out of pocket expense.

My PCP sent my letter out today! Next week I should hear from the surgeons office to set up my consultation. I can't wait!

I already did the psych evaluation. I've had 2 weigh ins but only 1 counts and my 3rd one next week (I need 6). But with the new insurance I'll only need 3 months of nutritional counseling. So I need to look into that.

Oh and it's mandatory by the surgeon to go to at least 2 support group meetings. I've missed the two available. So, I have to make Jan and Feb.. As long as everything runs smoothly and I do what I need to. I could have my surgery Mid-March.

So now, I tap my toes until I get the call

and thanks to everyone that posted here. Your information was helpful and eased my anxiety, a bit.

This helped me a lot too. I have bcbs federal and paperwork was submit this past Tuesday. Hopefully I'll get some good news this week!

[AhnaLucille 57]

I hope you get your approval soon kimdlawson06! best of luck!

[piaffe3 6]

Yes, I did take MMPI test. I passed. I didn't really realize you could pass or not pass, but the NP told me that she recvd 4 reports for the psychologist the day she received my results and I was the only one who "passed".

So what happens if you don't pass. More theraphy and then take it again?

[Gilyro 0]

Hey Ambwee,

Congratz on your success! I also have Federal Blue Cross Blue Sheild and I'm very interested in getting the gastric sleeve. I have done extensive research, but still have some doubts. Since I read your very positive post I was wondering if you didn't mind helping me out with some questions.

Thanks in advance,

Gilyro

[scoutmom 63]

@@karla23

Do you mind me asking if you had any co-morbitities and did you have to document them? I am submitting to Fed BCBS the first week of April and my BMI is 38. I realize I am in the "gray" zone and want to do whatever needed to get my approval.

Thanks!

[dekathe 11]

I also just started this process. I have BCBS FEP Standard. Current BMI 35 with co- morbidities. Was advised I needed 2 year weight history, 3 month physician supervised diet, see a nutritionist, and psychological evaluation. The baratric surgeon also wants me to see cardiologist and get and endoscopy. The concern is that my BMI the last two years was 33 so will go through process and hope my health issues will help with insurance approval.

[karla777 1]

Dekathe how did it go? Did fed bcbs approve u

[dekathe 11]

Still going through all the requirements. Don't anticipate submitted to BCBS until mid July. I will post outcome.