BCBS FEP approval experience please!

[Keenikwe 82]

I met with the surgical consult today. She said that she's sending my info for approval, but I thought there were 6 month requirements. I started on 1/10/17 and it's 3/28/17... so almost 3 months, but I have all the requirements completed.... I have my last emotional behavioral weight management session this Saturday and I have to be 6 months smoke-free. Can they still approval? I had my last cigarette on 1/10/17. When they told me I had to be smoke-free. I was down to just 1-2 an evening that I'd share with my husband.

The surgical consult (she was a PA) said to expect surgery to be scheduled and done within the next 6 weeks.

Any insight on this?

[trekker954 421]

There are two types of approval. There is your insurance carrier (FEP BCBS) and your surgeons requirements. They are different. I'm saying this because you are quoting numerous required emotional behavioral weight management sessions. This is NOT a FEP BCBS requirement. See below the Insurance requirement. Is a physician supervised diet required, yes. Is a Psych eval required, yes, but its typically one appointment. I was approved quickly, 2 days, by FEP. It is most important to collect all your documentation from your primary doctor and his his support. Mine wrote a great letter. I had his staff print out all of my visits regardless why I was there as everytime I went in as most doctors, you are weighed. That will show BCBS that you have been obese for at least 5 years. They don't really budge in their requirement and if they want to see a failed diet consecutive, its must be monthly. You cannot have skipped any month at all.

Now, my medical team wanted another whole slew of testing. Heart, lung, scans, sonograms, sleep study, it was endless and took forever (not really but it felt like that). So just know, that not everything they ask of you is for insurance. Once I knew I had all my insurance stuff, I insisted they sent that through. Why would I subject myself to some of the very invasive pre-tests if I wouldn't be approved.

And remember, if you want to self pay, the doctors don't even care about pre-tests or psych evals. Just give them the $50K and they'll be happy to get you scheduled the next day.

FEP BCBS miminum requirement

• Body Mass Index of 40 or greater OR BMI 35 or more with comorbidities.
• Documentation of failed diets by conservative treatment.
• Letter of support from primary care physician.

BCBS FLORIDA PRE-APPROVAL REQUIREMENTS

• BMI of 35 or greater
• Diagnosed as morbidly obese for at least 5 years
• Documentation of physician supervised non-surgical management weight loss program (e.g., diet, exercise, drugs) for at least 6 consecutive months
• No thyroid or endocrine disorders
• Psychological evaluation
• Letter from PCP supporting the medical necessity of weight loss surgery

[vamping 183]

FEP Blue user here and their requirement was 3 months in 2016. I don't believe that's changed. I'd definitely give them a call or contact them via secure messaging on the FEP Blue portal. They are infinitely helpful. As the previous poster said, what your surgeon requires may be a different thing.

[Redmaxx 740]

I have BCBS FEP and had surgery last year. It was 6 months but luckily I was on the MOVE program at the VA and that satisfied the requirements. So I had surgery about 40 days after my surgeon submitted everything to the insurance co.

[BackAgain 9]

I have FEP Blue and had RNY on 7 March. My initial submission was rejected because of no evidence that I was nicotine free for either 6 months or year ( can't recall right now what the standard wasc, but it's in the benefit guide). I've never smoked so I was surprised it was an issue. My surgeon then ordered a blood drawn nicotine test to meet BCBS requirements. This added like 2 weeks to my timeline, as the hospital could not do the test on site and had to send it out to LabCorp.

[mxpxchik11 48]

I am fed bcbs and my requirement was 3 month supervised weight loss. I was sleeved 3/29. I love bcbs mine was fully covered!

[Amy Turner 16]

On 4/11/2017 at 8:28 PM, Redmaxx said:

I have BCBS FEP and had surgery last year. It was 6 months but luckily I was on the MOVE program at the VA and that satisfied the requirements. So I had surgery about 40 days after my surgeon submitted everything to the insurance co.

Wow so lucky!! My insurance took so long for it

[Jencol 12]

Hmmm I'm BCBS Fed and I'm just beginning this journey. I told the patient coordinator I have Hashimotos and she didn't say a word. So that could be grounds for denial?