I have a BMI of 48. Was told on the phone that they would cover procedure if BMI was over 40. I also was told they only approve after you have all of the surgeons requirements are satified. So that leave me feel vernalble to having to self pay for all of the appointment I already have gone to if I get denied. Is therer snyone else out there who has had the surgery and federal BC/BS paided. Worried in Western Mass.

Peggy

Hello Scgardenlady, I believe that a lady I talk with on this thread N E 1 been Banded at Mt. Carmel col, oh has the same ins. as you so she may be able to tell you what the ins. paid for hers. her name is Debbie1 (something like that there is only three of that talk on that so She is the only Debbie, very nice and will help you out if she can. But in my case I have BCBS (not Federal) and It paid for my Dr. visit before for they approved me, the only bill that I had to pay up front was the "Shrink" to tell me I was sane:D. P.S We are in Ohio so there may be some difference. Any how Good luck.

I have a BMI of 48. Was told on the phone that they would cover procedure if BMI was over 40. I also was told they only approve after you have all of the surgeons requirements are satified. So that leave me feel vernalble to having to self pay for all of the appointment I already have gone to if I get denied. Is therer snyone else out there who has had the surgery and federal BC/BS paided. Worried in Western Mass.

Peggy

I have federal bcbs and was also concerned about having the surgery done without a "pre-approval" which they claim not to give. My bmi was 42 with no co-morbids. My surgeon submitted my current weight info as well as a medical history which required no documentation other than the info I gave them at my consult. My paperwork was sent to them on a Thursday and was approved by Monday.

They did send me a letter stating it was a covered procedure on my plan and pre-authorized my date of surgery. They paid both my hospital and surgeons bills and I came out owing a total of $200.00

BCBS Federal is fabulous!

I did have a little snag with the hospital billing department just before surgery where they thought I was going to owe $2k but I proved them wrong by calling my insurance and having them give me the benefits and then had the hospital call them back.

Congratts on your insurance and good luck with surgery. I had my surgery a month after my initial phone call to my surgeon!

Thanks so much for telling me your story. It has taken me a couple of months so far to get this thing going, but most of that has been for the things the surgean required. By next Monday I will have jumped through all of his hoops and then they will send it to the insurance company. I want to get the surgery before the end of the year because I have already met my deductible. I am in western Massachusetts and Dr Hagg is my doctor. I' let you know when I get a date.

Thanks, Peggy

Which plan do you have that has a deductible? Or are you talking about the max out of pocket?

I have BCBS standard and there is a 250.00 yearly deductable for partisapation surgeons and medical facilities. Haven't you ever noticed that? Maybe that is what the 200.00 you paid was for.

I have CareFirst BCBS under the Federal employee plan in Washington, DC. They started covering lapband in January. They told me you had to be at least 100 pounds overweight. They would not do a pre-approval. When I started seeing the surgeon I was more than 100 pounds overweight. I was banned in February (at that time less than 100 pounds overweight), and had to pay about $500 out-of-pocket for the surgery, hospital, etc. There have been no issues with my insurance coverage. Because it was early in the year, I had not yet met my deductable, which added to the cost. For the first 60 days, all of the follow-up visits with the surgeon were free. After that, I have been paying a co-pay of $15 per fill.

I have BCBS Federal. A pre approval (called a pre-service review) was not required by my insurance but my surgeons office required it and only because I had a BMI under 40 to make sure I had comorbidities that would qualify.

Youre surgeon appt will be covered whether or not you are approved.

I live in CA and I have a $100 copay for the surgeon and a $40 copay for the outpatient surgery center. I called my insurance to be sure there will be no surprises and they said that was all I will owe...Hopefully thats correct. Being banded 9/17.

Good luck!

I have BCBS FEB, Still waiting on the insurance for surgery, but Doc and hospit are in Network. Unfortunately the Shrink for the psych eval wasnt. She charged me $500, Submitted 2 bills to INS totalling $1265 Insurance says out of network is not covered and wont pay. the have given me net to nothing for credit on the out of pocket for it either. VERY FRUSTRATING. Any help or advice on how to fight that? I want $500 back form ins at least! I was on the phone with 2 incompitent ladies today. could not explain it to me and said that the allowable expenses were caluclated by using medicare fee schedules for my area for similiar services. WHAT THE F' OVER? They had no idea where these shcedules came from, but that they were in the system. They were annoyed that I could not understand. THEY WERE ANNOYED?!

Any Help?