Federal BCBS Standard KY

waiting2008 · October 25, 2008

While reviewing the benefit changes for 2009;I noticed this is the last year that Fed BCBS will allow the procedure without precertification. Fed BCBS has also increased the amount of co-insurance you owe in 2009. Keep in mind you owe everyone co-ins:the physician, the facility ect. So with this being said, if you are seriously considering having gastric bypass you might want to think about having it done this year.

Has anyone in Kentucky with Fed BCBS been through the process? How long did it take? Did you have to jump through hoops?

Phil · October 25, 2008

I have Fed BCBS of CA. I was banded 10/20. The aproval process took almost 4 weeks. Should have been less but the paper work was missing an item and went back and forth a couple of times for almost 2 weeks. A bump or 2 in the road seems to be pretty common. I found that placeing a friendly, very humble phone call every coupled of days kept the ball rolling or got things back on track after they stalled. At each stage I simple gave BCBS a call and asked if I could check on the status because I wasn't sure what the Surgeons staff had submitted, they generally responded really well. At the end of the call I would also ask aproximately how long the next step would take. Then I'd wait an extra day and give them a call back. I also did the same thing when the ball was in the DRs court. I would politely inquire on the status cause I told them I wasn't getting the best of information from BCBS or I would call to update them based on the info I received from BCBS. My experience was that there's equal potential from the Drs staff as well as BCBS for causing delays. I tried not to be a pest but definately didn't hesitate to look out for my own best interest. Stay on top of them and try killing them with kindness first, but stay firm.

bklyn1984 · December 4, 2008

While reviewing the benefit changes for 2009;I noticed this is the last year that Fed BCBS will allow the procedure without precertification. Fed BCBS has also increased the amount of co-insurance you owe in 2009. Keep in mind you owe everyone co-ins:the physician, the facility ect. So with this being said, if you are seriously considering having gastric bypass you might want to think about having it done this year.
Has anyone in Kentucky with Fed BCBS been through the process? How long did it take? Did you have to jump through hoops?

FYI this pre-cert applies to outpatient surgery in addition to inpatient which has always required pre-cert. The amount of money they are charging out of pocket in 2009 is unbelievable. Make 100% sure that everyone is in network or you will pay. Check your hospital, your surgeon, your radiology group for the hospital, and your anesthesiology group for the hospital. Just because your hospital is in network does not mean everyone else is. I found this out the hard way and since then I check everyone prior to anything. I turned down a lap band surgeon because the anesthesiology group was out of network.

What's the difference between Kentucky and any other state? Isn't BCBS Federal the same for all states? I know that the claims are handled in different offices through out the US but aren't the benefits the same for all?

I do not know what hoops anyone has had to jump through but I will find out soon enough because this week my file is going to the insurance and my surgery date is January 9th and this waiting is the worst part of the preparation. I just hope that it will be a quick decision.

FatManInALittleCoat · December 14, 2008

Well this doesnt sound good. I have federal bcbs standard and Im just now in the "research" phase. Whats wrong with precertification? Is it a big deal?

snowbird · December 14, 2008

I had inpatient surgery in Mexico in 2007 and BCBS federal did not require pre certification. I filed an overseas form and they reimbursed me, but when I called to ask they said there was no pre-certification regardless of where I had it done.

In some ways, pre cert is better than hoping and praying they are going to cover the surgery. Before, they would just say if you met the criteria they would pay, and then you had to worry that you read everything correctly and they accepted your doctor's statement of co morbidities etc.