I'm just wondering... has anyone had to wait to complete a 6 month diet plan or whatever? With FEDERAL Blue Cross Blue Shield Basic or Standard?

From the first time you saw the doctor... how long did it take you to have the surgery and what was the process?

Hi,

I do Bariatric surgery insurance approvals for a living. I work in the DFW area. BCBS Fed DOES NOT require a 6 month diet. They don't require psych eval, or nutrition appt either. When I submit to BCBS I always have the same nurse call me back for clinical info. She only asks current height, weight and BMI and any co-morbid conditions. They won't give you an approval ahead of time for outpatient surgery so we always do our Lap Bands inpatient for BCBS Fed patients so we can get the pre approval done. If you can get in to see someone and get them to get you submitted quickly you should be approved in just a few days.

Good Luck!

Kathy

I have BCBS fed basic also. The bariatric center I went to said it does not require 6 mon supervised diet but since I reside in Tx and having surgery in Tx then I had to follow BCBS Tx plan and it requires the 6 mon diet. I've since started the 6 mon diet with my PCP. I'd love to know if this is incorrect. I'd much rather have my surgery now than wait 3 more months completing the diet.

Me personally...from the 4 offices I have talked to. I don't think it is required..... I think the office is either a) more used to doing regular bcbs and gets it confused... the office is looking at it as .... what if the insurance comes back and says that it is required? Who pays for the procedure then? They are trying to cover their butts. The insurance doesn't give pre-auth like regular insurances..... that is why they are trying to cross all corners in case something is wrong and the insurance asks for more.

I may be wrong... but, that is what I have gathered by calling several different offices and asking questions. I'm just that way... I do alot of research especially with something this major.... i read online and asked questions....compared...and called offices and asked questions..and compared.

I want to see it in writing tho that it is not required. I have yet to find it.....

I'll let u know what happens after I go to my first appointment Nov 14th.

Where do you live?

Hi,

I do Bariatric surgery insurance approvals for a living. I work in the DFW area. BCBS Fed DOES NOT require a 6 month diet. They don't require psych eval, or nutrition appt either. When I submit to BCBS I always have the same nurse call me back for clinical info. She only asks current height, weight and BMI and any co-morbid conditions. They won't give you an approval ahead of time for outpatient surgery so we always do our Lap Bands inpatient for BCBS Fed patients so we can get the pre approval done. If you can get in to see someone and get them to get you submitted quickly you should be approved in just a few days.

Good Luck!

Kathy

You are right on the money! Thank you for clearing it up! You put all the pieces of the puzzle together for me. Thanks

I heard that if it is done out-patient.... you are also responsible for some of the cost of the band itself. If it is done inpatient you are not. I asked the lady today about that...and she said their clinic requires it to be inpatient so not to worry. She said I would get the approval in like 3 days once it is submitted. Does that sound right Kathy?

I guess my clinic is going to do the psych and nutritionist as their requirement...which is not a big deal. She said I can do all that when I have my first appointment with the surgeon.

Edited October 29, 200817 yr by creed2474

Yes that sounds right. Sometimes if I submit in the morning I get approval the same day. It will be quick for you!!

Yes that sounds right. Sometimes if I submit in the morning I get approval the same day. It will be quick for you!!

Can you pm me and tell me what clinic you work for? I just want to be able to compare doctors.

Yes, she asked my height, weight....and I told her I was diagnosed with sleep apnea and I have a cpap machine....

she then said...we consider you as a "slam dunk" patient. lol

Good Morning;

The website is www.fepblue.org; go to the tab "benefit plans". The left side of the page will have the different plans; choose the appropriate policy, then go to medical benefits. If you have to download the booklet, gastric surgeries are discussed on page 49.I have spoke with a representative at Anthem Federal and was told there was no 6 month supervised diet required; as long as the other criteria is met. You may also review the policy changes for 2009.Precertification will be required in 2009 for these procedures. I am working hard to get this done before the end of the year. I wish you the best of luck!

Yeah, that is why i'm pressing to have mine done ASAP. Hopefully December!!!!

Kathy, thank you sooooooooooooo much for the info you provided. I called my BCBS today. At first her answers were very vague then I told her what you said on here and she then she admitted the 6 mon supervised diet was not required. I'm still having a problem with the bariatric center. They still think it is required. I don't think they know what they are doing..anyway, tomorrow I'm going to the office and talk with them in person and I'm going to ask them to submit my paperwork to BCBS. I have the 5 yr wt documentation, Bmi 44 plus two co morbidities, and I listed several wt loss attempts in the past which covers the failed conservative treatments. Hopefully I will be approved...thank you again for your help

For those with BC FEP, the insurance doesn't require the 6 month supervised diet. The surgeon might require it, but not the insurance. Same for the psych eval.

If you have surgery as an out-patient, with FEP BC Basic you'll probably get billed for a portion of the cost of the band, which could amount to about $1,000. For in-patient, you don't have to pay a portion of the device cost.

I'm not sure about FEP BC Standard plan.

NOTE: This is for FEP Blue Cross, not for BC from any other employer.

Kathy, thank you sooooooooooooo much for the info you provided. I called my BCBS today. At first her answers were very vague then I told her what you said on here and she then she admitted the 6 mon supervised diet was not required. I'm still having a problem with the bariatric center. They still think it is required. I don't think they know what they are doing..anyway, tomorrow I'm going to the office and talk with them in person and I'm going to ask them to submit my paperwork to BCBS. I have the 5 yr wt documentation, Bmi 44 plus two co morbidities, and I listed several wt loss attempts in the past which covers the failed conservative treatments. Hopefully I will be approved...thank you again for your help

gumbo- you never let us know what happened.... did you talk to them about it?

Creed, when I talked to the bariatric center they said they wanted it in writing from BCBS fep that the 6 mon supervised diet was not required. I called BCBS fep back asking for this and they said I was given the wrong information by them when I had previously called. That I had to follow BCBS TX criteria and that it was required. It seems you can't even rely on info given by your ins carrier. I'll continue with the supervised diet and hope for approval when completed..

I have BCBS FED Basic and was banded on August. I had to have a psych eval because my doc required it. No waiting period. It was billed as outpatient because I only stayed one night. Had to pay 30% of the band cost and a portion of the meds. My bill is 2500.

I'm a long term Federal Employee and have BCBS FEP Basic. There is no 6 month waiting, but (as stated by others) each doctor has different requirements as far as Psych/Nutrionist/etc. As long as you are covered by the plan it will pay, federal insurances have no pre-existing exclusions in any of their policies, and also part time employees receive the same plans/benefits as full time, but the premiums CAN differ based on the amount of hours you work. :thumbup:

yeah I found out my premium is really high because I am part-time...but, it is worth it.

I'm going with a doctors office who knows the insurance very well. It is a 3 hour drive but I feel very safe to know that they know what they are doing.

I will have double coverage...but my primary insurance does not cover anything related to weight loss surgery. So, my secondary which is bcbsfed hopefully will cover everything.... what I wonder is will my primary cover those two 100 dollar co-pays?

And, if I ever lose my fed plan... will the primary (who says doesn't cover anything) kick in and pay for follow-ups and fills, etc. related to the surgery.

Yes, part time federal employees pay higher premiums when they work over 15, but under 40 hours per week. Interestingly enough, if you only work 15 hours per work (been there myself) you pay the same premium as a full timer, but over 15 until full time you pay a prorated amount.

As for who the other insurance questions, I don't know. That stuff is pretty sticky....just try to hang on to the federal plan.:tongue2: