Approvals with BCBS Federal

[PlBren 21]

I just found out that my doctors office still hasn't submitted my paperwork to BC/BS Fed yet - and it has been 11 days since my last visit and everything was ready to go then! Ugh. If the insurance company doesn't get back to me in a week or less, I'm going to have to change my whole schedule around because I was counting on a Aug 27th surgery date.

[Oklahomagirl1970 4]

Wow.. That's crazy that it's taking so long!

[liltextornados2015 4]

I just found out that my doctors office still hasn't submitted my paperwork to BC/BS Fed yet - and it has been 11 days since my last visit and everything was ready to go then! Ugh. If the insurance company doesn't get back to me in a week or less, I'm going to have to change my whole schedule around because I was counting on a Aug 27th surgery date.

Sorry to hear. Hopefully the ins replies back asap to u.

[lisa1662 3]

I have that insurance and was approved. VSG scheduled August 12

[nomoremeds 27]

I just received my approval letter in the mail from bcbs. My doctors office still hasn't scheduled me for surgery

[SleeveandRNYchica 1,155]

My insurance coordinator makes me want to change doctors she is the most non responsive individual and it is highly annoying!!!

[PlBren 21]

I have that insurance and was approved. VSG scheduled August 12

Lisa -

How long did your approval take? What is your BMI and do you have any co-morbidities?

[babbs2299 15]

I don't understand why it's different for some people with the BCBS (fed) than it is for me. Wouldn't the insurance all be the same? I do know the surgeons office makes a big difference in how things move along but I figured everything else would be the same. Things that make you go Hmmmm.

[SleeveandRNYchica 1,155]

I just found out that my doctors office still hasn't submitted my paperwork to BC/BS Fed yet - and it has been 11 days since my last visit and everything was ready to go then! Ugh. If the insurance company doesn't get back to me in a week or less, I'm going to have to change my whole schedule around because I was counting on a Aug 27th surgery date.

Did they submit?

[SleeveandRNYchica 1,155]

I have BCBS (federal employee program). I have the one with PPO, not sure if it's called standard or basic. I do know it's the more expensive of the two. ???? I've started the process for my sleeve just within this month. My BMI is 41.7, I have sleep apnea but otherwise very healthy it seems. All it really is for me now is just a waiting game, and the insurance required 3 more appts, one of which has to be with the dietician. The surgery coordinator said we'll be scheduling the surgery on my 3rd visit. This is what was/is required of me for insurance...

1. PCP medical clearance signed that your safe for surgery and that the procedure is needed..........................completed and turned in

2. Psych. Evaluation which was a 40 minute session with a lady that had sleeve 6 months prior by same surgeon..............completed and turned in

3. History of weight loss attempts by me, how, etc. Basically a handwritten "weight loss resume"........completed and turned in

4. 3 month required waiting game that includes 4 official "visits" to the surgeons office, one of which has to be the dietician/nutritionist..........1 visit completed with the second one scheduled in about a week and a half and that's with the nutritionist.

That's all that is required for me to get approval. I'm hoping that I can get a late October, early November time slot for the table. Fingers crossed!!!

Why do you think your requirements are so different? It is pretty much the same. I think the surgeons requirements vary.

[PlBren 21]

I just found out that my doctors office still hasn't submitted my paperwork to BC/BS Fed yet - and it has been 11 days since my last visit and everything was ready to go then! Ugh. If the insurance company doesn't get back to me in a week or less, I'm going to have to change my whole schedule around because I was counting on a Aug 27th surgery date.

Did they submit?

Yes - I called back today and was told the paperwork was submitted. Now they waiting game begins. I was told give it a full week before I start bugging them.

[babbs2299 15]

SleevenChica....I'll go with what you said. The requirements from the surgeon are the big difference in each of our journeys with BCBS and the sleeve surgery. I was actually so curious I called them after seeing your post and sure enough you were spot on.

[SleeveandRNYchica 1,155]

I know my surgeons requirements are different. I have done everything through them. I will post my costs and timeline when I get home! Glad you got clarification.

[SleeveandRNYchica 1,155]

So my breakdown with my surgical group goes like this:

$730 paid in two payments for all wellness consults, pre bad post op nutrition appointments,patient material and weight loss nutrition class

$150 for 3 month nutrition program

$300 for Bariatric Advantage liquid diet

$153 for Bypass Vitamin kit

This is my upfront out of pocket cost totally $1333.

Additionally, since I already met with their Behavioral Specialist I went with her for the psychological exam for an added costs of $225. I decided to go with her because when I called another psych he told me my insurance would cover the appointment, but not his time to right the report for additional $175. So with copay I would have been close to $225 anyway!

I also had to have Barium Swallow copay $40 (I think) and EDG copay $100.

I will have my surgery at a Center of Excellence so I think the copay is $150. The office told me lost surgery I will get a letter of necessity in which I can then submit to my insurance for possible reimbursement. Since these are considered wellness providers procedure codes are nonexistent.

So when it's said and done it will be close to $2k. Not to mention this is my second rodeo.

[nomoremeds 27]

Sleevenchica do you have basic or standard?