Mississippi Federal BCBS

MsGulfCoast · August 21, 2008

My husband is a federal employee and is considering switching to Federal BCBS next open season, either Oct or Nov. Does anyone know if MS BCBS covers lap band surgery and, if so, what are the requirements? What was your experience?

I just had my first visit at Dr. Avara's office in Ocean Springs last night. Setting out on my 6 month worth of visits with a local FP. I have a BMI of 40, not diabetic, not been diagnosed with hypertension. I don't want to HAVE to life threatening illnesses for insurance to pay for this surgery....that is why I want the surgery! Argh. :thumbup:

Thanks so much!

justmel1957 · August 21, 2008

I am a federal employee with the Federal BCBS. I carry the basic option. My surgery was covered with just a small co-pay ($100) and my fills/visits are a $30 co pay each visit. Not bad at all. I live in Illinois, but had surgery in Kentucky with no problems. I had a lower BMI (37) and not many co-morbidities. (bad reflux, minor BP, some back pain, etc).

Fep Blue covers banding..........but you have to be approved thru the state you are having the surgery in. Good luck. Just be sure your doc is a BCBS provider.

MsGulfCoast · August 21, 2008

Thank you for your response! So, Fed BCBS does not require for someone to have significant comorbidities, such as hypertension, diabetes, etc.? If so, that's great! Like I said, I want to avoid having those problems, that is one of the reasons I want this surgery.

I'm going to go ahead and tell my husband to switch from GEHA to FEP BCBS next enrollment and go from there. You mentioned you work in one state but had the surgery in another....BCBS allows this? So, if need be, even though we will have MS BCBS I could go to Louisiana and have this done if I needed to and it would be covered?

Thanks again!

LisaB411 · August 21, 2008

I am a Federal Employee, and I did a lot of research on health insurance plans before I had my surgery. I switched to BCBS Federal because they did not require a supervised weight loss program to get approved for surgery. My doctor said they are one of the easiest plans to work with and they approved me in 20 minutes. My doctor and hospital were all "in network," so my costs so far for the surgery, office visits, and fills is less than $500 total.

LISAMARIE1158 · August 21, 2008

l too have Mass Federal B/C basic option..They have been great..Only psych and nutrition appts were required. my co-pays have been $20.00 and l will owe the hospital $100.00 for the surgery. lt took me about 4 weeks to get approved, so don't get discouraged..l called them weekly until l had my approval. They have been very good to deal with..Through my phone calls with B/C l found out that many of the people answering the phone had already had the surgery so there was a bit of human compassion built into the conversations. Good Luck to you...Open season starts in Nov with coverage starting in January...

MsGulfCoast · August 21, 2008

I am enquiring about Mississippi BCBS, not Massachusetts but your information is very encouraging! I am starting my six month doctor visits this month. If I end up not needing it...great, but if I do I will already have documentation.

I am anxious and nervous at the same time! Thank you again for your very positive information.

MsGulfCoast · August 21, 2008

Lisa...that is wonderful news about how quickly you were approved and without having to do the six month doctor visit! I sure hope that is how MS BCBS works! You have me thinking very positive thoughts now, which I needed dearly. Thank you!

justmel1957 · August 21, 2008

Thank you for your response! So, Fed BCBS does not require for someone to have significant comorbidities, such as hypertension, diabetes, etc.? If so, that's great! Like I said, I want to avoid having those problems, that is one of the reasons I want this surgery.
I'm going to go ahead and tell my husband to switch from GEHA to FEP BCBS next enrollment and go from there. You mentioned you work in one state but had the surgery in another....BCBS allows this? So, if need be, even though we will have MS BCBS I could go to Louisiana and have this done if I needed to and it would be covered?

Thanks again!

Yes, you can have surgery anywhere that is a BCBS provider. Some states might be more leanient on approvals, so ask around. You may decide that a border state might have faster and easier processing. The state you are having the surgery in, is the state that will review and approve/deny it. Not your residing state.

I think if your BMI is on the lower end, you do probably need to supply any co-morbidities even if they seem minor to you. I rec'd my approval in about 2 weeks.

LisaB411 · August 21, 2008

A lot of how fast you get approved and whether you need to have co-morbitities depends on what you BMI is. If your BMI is lower than 40, you are probably going to need some comorbidities to get approved. You may want to pick a surgeon you like first, then ask him/her what insurance they find it easiest to work with.

MsGulfCoast · August 21, 2008

I just found out from the insurance clerk at my proposed surgeon's office that BCBS requires 5 years' worth of documentation of being overweight. I do not have that information. So, I am sticking with my current insurance, which only requires six months of doctor supervised diet. With any luck, I'll be banded no later than March of next year. Yay!

justmel1957 · August 21, 2008

I just found out from the insurance clerk at my proposed surgeon's office that BCBS requires 5 years' worth of documentation of being overweight. I do not have that information. So, I am sticking with my current insurance, which only requires six months of doctor supervised diet. With any luck, I'll be banded no later than March of next year. Yay!

I submitted the 5 year documentation, but it wasnt a big deal. I just typed out the various diets I had been on, my approx loss and regain and the office submitted it along with my "plea" letter and other tests that were required.

mississippigurl · August 21, 2008

The 5-year documentation is really easy, you just have to list all of the different diets you have tried and approximate dates of each. Very simple... It took me a little longer (4-5wks) to get my Fed MS BCBS approved but some of it was a delay at my docs office. I was banded on 8/5/08. The MS BCBS insurance process was actually very easy and even psych eval was paid for and my initial consult with the doc... Good luck!!

jawent · August 22, 2008

I live in NC and have BCBS Federal - Basic Option. I have had all of my tests completed and I am waiting for them to reach the surgeon. The insurance company requires 5 years of weight history. You must have a BMI of 40 (with no other comorbity) or a BMI of 35 (with comorbity) for 4 of the 5 years. I have two years that are 40, and two years that are between 35-40 and one year less than 35. BCBS will NOT preapprove my surgery because it is outpatient. If I was having gastric bypass, they would preapprove me. All I can do is have the surgery and then submit my paperwork and hope they cover it. I am taking that leap of faith and having the surgery. I think I can write a convincing letter about the two years that do not have a BMI of over 40. I'm expecting to have a surgery date of less than one month ... I can't wait. j

justmel1957 · August 22, 2008

I live in NC and have BCBS Federal - Basic Option. I have had all of my tests completed and I am waiting for them to reach the surgeon. The insurance company requires 5 years of weight history. You must have a BMI of 40 (with no other comorbity) or a BMI of 35 (with comorbity) for 4 of the 5 years. I have two years that are 40, and two years that are between 35-40 and one year less than 35. BCBS will NOT preapprove my surgery because it is outpatient. If I was having gastric bypass, they would preapprove me. All I can do is have the surgery and then submit my paperwork and hope they cover it. I am taking that leap of faith and having the surgery. I think I can write a convincing letter about the two years that do not have a BMI of over 40. I'm expecting to have a surgery date of less than one month ... I can't wait. j

Good luck to you..............keep us posted.

Altho I didnt get a pre-cert number as you would with an admission, I did receive a letter stating that i met the requirements for the LB and that my surgery would be paid. I got that about a week before I had the surgery. Kentucky also faxed my doctor and me a "pre-determination" coverage letter.

Hope everything works out for you..............

pennyt · August 23, 2008

I have FEP Blue basic, and didn't have to have the five year history. I was approved very quickly. The insurance coordinator at my surgeon's office said FEP Blue is the easiest to get approved if you are over 40 BMI.