Approvals with BCBS Federal

[daniellenf 15]

I am 23 with a bmi of 43.5. I also have federal employee bcbs and am nervous about approval. What all did they require from you? I meet with my surgeon 8/6.

[rln52 136]

The 2 year weight history, nutritionist visit, EGD Colonoscopy, annual mammogram, 3 consecutive months of supervised weight management. sleep apnea test. I think that was it. It took about 5 months for me to get it all done or collect reports from other doctors for my surgeon.

[daniellenf 15]

The 2 year weight history, nutritionist visit, EGD Colonoscopy, annual mammogram, 3 consecutive months of supervised weight management. sleep apnea test. I think that was it. It took about 5 months for me to get it all done or collect reports from other doctors for my surgeon.

Thank you!

[nomoremeds 27]

My paperwork was submitted to BCBS Fep on June 22nd. My Doctors office called and told me that BCBS is now requiring 4 nutritional visits. I went to the additional visit on July14th. I still hadn't heard anything form my doctors office on the 24th so I decided to call the insurance company myself. I was told that my surgery was approved on July 20th. The approval was for 184 days, so I have until January 20th 2016 to have the procedure done. I started my journey in April of 2015 and I'm not quite sure why the doctors office hasn't notified me that I;ve been approved so I can get a surgery date. I'm going to call them in the morning.

[SleeveandRNYchica 1,155]

My paperwork was submitted to BCBS Fep on June 22nd. My Doctors office called and told me that BCBS is now requiring 4 nutritional visits. I went to the additional visit on July14th. I still hadn't heard anything form my doctors office on the 24th so I decided to call the insurance company myself. I was told that my surgery was approved on July 20th. The approval was for 184 days, so I have until January 20th 2016 to have the procedure done. I started my journey in April of 2015 and I'm not quite sure why the doctors office hasn't notified me that I;ve been approved so I can get a surgery date. I'm going to call them in the morning.

Are you sure it is 4 visits vs 90 days? Mine dates are/were- June 3 (1st session), July 15th (2nd session) August 8th (third session); however, I will not reach 90 days until September 3rd. So my 90 day appt or 4th visit is just a weigh in.

This is from the brochure:

Benefitsforthesurgicaltreatmentofmorbidobesity, 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 62) 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 40 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 97 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

[rln52 136]

Do you think maybe that is a new requirement? I first saw my doctor in September 2014 then I chickened out and went back in February 2015. Maybe after then they changed number of required supervised weight management visits.

[nomoremeds 27]

Yes. She said it was a new requirement. I thought it was odd that they would add it mid stream. I could understand if it was for those who were beginning the process.

[rln52 136]

I just want to hear from them waiting is a bummer. Going to call again on Wednesday.

[PlBren 21]

SleevenChicka - You wrote:

This is from the brochure:

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 62) 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 40 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 97 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

Where did you read this? I am on the fepblue.org website now and see absolutely no information at all about bariatric weight loss surgery. My info is getting submitted this week - now I am getting worried. Also - for those of you who have BC/BS Federal, do you have basic or standard option?

[PlBren 21]

That is great you were approved, but horrible of the doctor to not tell you themselves!

Can I ask if you have any co-morbidities? I only have the sleep apnea, and history of being overweight, but my BMI is only 38.

My paperwork was submitted to BCBS Fep on June 22nd. My Doctors office called and told me that BCBS is now requiring 4 nutritional visits. I went to the additional visit on July14th. I still hadn't heard anything form my doctors office on the 24th so I decided to call the insurance company myself. I was told that my surgery was approved on July 20th. The approval was for 184 days, so I have until January 20th 2016 to have the procedure done. I started my journey in April of 2015 and I'm not quite sure why the doctors office hasn't notified me that I;ve been approved so I can get a surgery date. I'm going to call them in the morning.

[nomoremeds 27]

High blood pressure and high cholesterol. I have a lot of joint pain when I ride from a resting position

[nomoremeds 27]

I have basic.

[liltextornados2015 4]

I just want to hear from them waiting is a bummer. Going to call again on Wednesday.

Still nothing ugh :/ I called today but everything is still as scheduled for me on friday. Wish me luck in getting that approval before friday.

[daniellenf 15]

I wish all of who are waiting luck!!!! I think right now that is what I am most nervous about.

[SleeveandRNYchica 1,155]

SleevenChicka - You wrote:

This is from the brochure:

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 62) 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 40 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 97 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

Where did you read this? I am on the fepblue.org website now and see absolutely no information at all about bariatric weight loss surgery. My info is getting submitted this week - now I am getting worried. Also - for those of you who have BC/BS Federal, do you have basic or standard option?

Go to the FEPBLUE website and download the 2015 benefit manual. I think it is like pg 67 or 68.