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Letter of Support -BCBS Fep Question

_CRYSTALLITE_

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_CRYSTALLITE_    6

_CRYSTALLITE_
Posted

I finally got my letter of support from my pcp(I had to jump thru hoops to get one). Well the insurance lady told me that the letter needed to state that I haven't smoked or drank alcohol within the last six months or something like that or the insurance will deny it. Of course My doctor didn't put it on there. It took me forever to get the letter and I don't want to delay them submitting my paperwork because I'm trying to hunt down my pcp. And I certainly don't want to get a denial because the statement isn't on there.

My question is for anyone with BCBS federal, do you really have to have this statement on there? Was anybody denied because they didn't have it on there?

Do you think I should have my pcp to add the statement?

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KristenLe    5,979

KristenLe
Posted

@@_CRYSTALLITE_ I don't know if a PCP will attest to that - particularly alcohol (how would they know other than by your word). I've also never heard of that requirement before. Maybe to say you haven't had any drinking problems to their knowledge. The PCP records should document smoking history and be able to confirm that (or submit your records).

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Jellybean55    14

Jellybean55
Posted

I have the same insurance, to my knowledge my Dr. didn't have to say I hadn't drank in 6 months, I did drink moderately prior to surgery. I quit smoking 34 years ago so that wasn't an issue. My understanding is that if you do smoke, you have to quit 2 mos. before surgery. Good Luck.

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nickisleeve    127

nickisleeve
Posted

I have BCBS Federal and my PCP just had to note that I was healthy enough to under wls surgery.

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_CRYSTALLITE_    6

_CRYSTALLITE_
Posted

Thanks for the replies! I will be going to my last appointment on Friday and then everything will be submitted. So hopefully everything goes well and I'm approved.

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trekker954    421

trekker954
Posted

I have bcbs fep and my pcp did not need any such statement. I don't smoke but was quite the wino pre surgery. Lol

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_CRYSTALLITE_    6

_CRYSTALLITE_
Posted

@@Nana1222 I have bcbs fed basic, I had to wait 3 months with a nutritionist or pcp. I decided to go to a nutritionist.

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vamping    183

vamping
Posted

I have the bcbs fed basic and didn't have to provide a letter from a pc. I just self referrer straight to my surgeon. The drug and alcohol question was included in my psych evaluation.

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trekker954    421

trekker954
Posted

I made sure that all of their requirements were met. The months of consecutive diet with my pcp had to be detailed was probably the most concrete evidence of failed attempts, psych, sleep apnea diagnosis, and other required clearances. My pcp letter of support was excellent. After we submitted, it took less than 2 days.

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Nana, doesn't sound like yours is federal bcbd.

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ALittleMe0914    69

ALittleMe0914
Posted

@@_CRYSTALLITE_ I work in insurance and have obtained prior authorizations before from all types of BCBS plans. From what I have seen, most of the plans that require documentation from a PCP only required "clearance" from them, meaning that they will document that you are physically a good candidate for surgery based on your medical history and you don't have any health issues that would cause higher risk for complications.

With that said, I think you should be fine with a letter from your PCP clearing you for surgery and whatever documentation your surgeon sends over to them. Sometimes they will ask for more records to base their decision on, but I haven't seen much more than that. Also, I don't think your PCP can document your smoking/drinking habits because the PCP only goes on what you say. They might just be able to state that you don't have a history of smoking and/or alcohol abuse according to their records.

Fingers crossed that you have no trouble!

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SharBear617    146

SharBear617
Posted

I have BCBS Fed emp also, I don't believe my pcp letter had to say any of that, but my surgeon's office gave me a "sample template" to give to my pcp for what they recommend the letter to entail. My surgery was approved in about a week once my surgeon's office submitted everything.

I've never smoked in my life, but my surgeon includes a blood test for nicotine in the pre-op lab work because the surgeon will cancel surgery for anyone that's still smoking. I guess because I never smoked I didn't really pay attention at all to any of that because I knew it wasn't a factor.

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