Insurance Questions - BCBS Federal

[taxudown 44]

So, I recently did an online seminar for Vanderbilt University Medical Center Bariatric Surgery. I 4/16/16 for the first appointment. They said it should take about 4-5 hours, and you meet doctors, nutritionist, Gastro nurse, and insurance "specialist".

My concern for me - I think BCBS Fed requires 6 months supervised diet/WL program. I do not have a PCP - I'm 28 and never really been to the dr all that often. I did about 6 months of phentermine years ago and for the last 1 1/2 years, I've had a personal trainer 2-3 times per week.

What's going to happen? I have seen a dr in my new town a couple times for low blood sugar, but nothing really major.

I'm about 365 BMI 51.

Any thoughts? IS there a way to get around the 6 month supervised thing?

[kmorri 1,689]

Hi I think there is someone else on here that have bcbs federal....her screen name is @@MeFirst She may be able to answer some of your questions. She just had her surgery recently. Good luck!

[taxudown 44]

Thanks for the lead - is there a way to contact her OR do you have to wait on a reply. I just signed up for this a few days ago.

Thanks!

[Miss Mac 6,261]

BCBS Request for approval.docxRetired V A here. I had to provide two years of proof of doctor's supervision. What I did was have them print out two years of medical records and I highlighted every place that my weight was recorded and all of the doctor's comments or instructions regarding my weight.

For the surgery I had to have a three month supervised diet with my bariatric team. What I did for extra was to write BCBS a letter explaining how my weight and co-morbidities affect my health and quality of life. As soon as my program packet was submitted to BCBS, I was approved for a 5 day hospital stay, in only two business days.

I am sharing with you an editable copy of my letter to give you some inspiration. Feel free to adjust it as needed for yourself. I am also giving you a co-morbidities list.

Here is a list of common co-mobidities that the insurance companies consider. The information is from a U S Government website called the National Instititute of Health. I hope this helps.

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

[silverthreads 183]

I have BCBS Federal and have been approved for VSG. You need to get the online brochure from fepblue.org and search for the word "bariatric". You'll quickly find their requirements. I sent in a package showing I met their stated criteria, had done the required steps, and was approved. One thing was that their online provider directory didn't list any bariatric surgeons so I upgraded to the Standard plan (more expensive but has out of network coverage). When they approved my surgery they told me about two local practices that are in network--I should have called to ask. That mistake cost me a few thousand buy I'm not changing horses midstream--still using the out of network surgeon.

Good luck!

Sent from my iPhone using the BariatricPal App

[taxudown 44]

@@Miss Mac and @@silverthreads

Thank you so much! I was very pleased to see that FED BCBS required 3 months of supervised plan. That's great. I was hoping I would be able to do my surgery in July if things went right. I have been morbidly obese nearly my entire life. I actually have gained 15 pounds after being with a trainer for 1 1/2 years (which isn't cheap). I was surprised when I told my trainer of my plan yesterday that he was positive and supportive. I go to law school August - May of the year, so need it in the summer and really don't want to wait until next summer.

I really appreciate all of your comments.

[165B445 188]

So, I recently did an online seminar for Vanderbilt University Medical Center Bariatric Surgery. I 4/16/16 for the first appointment. They said it should take about 4-5 hours, and you meet doctors, nutritionist, Gastro nurse, and insurance "specialist".

My concern for me - I think BCBS Fed requires 6 months supervised diet/WL program. I do not have a PCP - I'm 28 and never really been to the dr all that often. I did about 6 months of phentermine years ago and for the last 1 1/2 years, I've had a personal trainer 2-3 times per week.

What's going to happen? I have seen a dr in my new town a couple times for low blood sugar, but nothing really major.

I'm about 365 BMI 51.

Any thoughts? IS there a way to get around the 6 month supervised thing?

Yeah BC/BS fed is what I have... and they made me do 90 day supervised with NUT... along with other specialists so it took me since Sept... my date for destiny is May 18...

Sent from my SAMSUNG-SM-G530AZ using the BariatricPal App

[silverthreads 183]

Be sure you look up the plan brochure online--there is more than just the 3-month medically supervised weight loss program -- most of the rest is pretty easy (psych clearance, NUT consult, etc) but still takes time. The hardest for me was records that I was beyond the threshold BMI for 2-3 years. I was, but finding a record that I didn't create myself was tricky. My PCP didn't often weigh me so not much there. Fortunately my local Weight Watchers was able to print out 5 year old records (I didn't keep the originals). So do your lawyering--look at the book, find the specific requirements and build your case!