Federal BCBS
I just posted this on the RNY message board:
Hello all,
I've been lurking for a while now trying to find someone with insurance similar to mine. I've found several federal employees but none that actually live in IL; but I'm open to advice from anyone. I was just wondering if anyone had any trouble with getting approval from FEP BCBS.I ask b/c there is a LOT of confusion about the 6 month pre-op diet for federal employees in IL. The brochure as well as the people at the ins co states that the diet is not required but the insurance coordinator at the surgeon's office said that the rep she spoke with told her to look at the guidelines for BCBS of IL for the requirements. I had also been told that until I told the rep that I am a federal employee and it's not the same as the state plan. (FYI when you look at all the other health ins brochures like Aetna and GEHA it specifically states that a pre-op diet is required,BC does not have that listed). She finally asked a supervisor who informed her that I was correct and they were only looking for BMI and co-morbids. But I'm still a bit nervous b/c my surgeon's office was given wrong info. And it's funny too b/c when I met the surgeon and he asked about my insurance he perked up when I told him I had federal BC; he said that they are the easiest to get approved and only require the BMI and comorbids. By the way my BMI is 41 and I have diabetes and high cholesterol.
I have experience with this as I used to work for a major insurance company in the UM/precert department. I'm familiar with the entire process but not as a federal employee with BCBS. My info was submitted on Wednesday morning and we're waiting to hear back (it's for lap RNY). If anyone out there is a federal employee I could use some of their personal experiences for comfort.
Thanks in advance!!!!!
Daisy
Hello all,
I've been lurking for a while now trying to find someone with insurance similar to mine. I've found several federal employees but none that actually live in IL; but I'm open to advice from anyone. I was just wondering if anyone had any trouble with getting approval from FEP BCBS.I ask b/c there is a LOT of confusion about the 6 month pre-op diet for federal employees in IL. The brochure as well as the people at the ins co states that the diet is not required but the insurance coordinator at the surgeon's office said that the rep she spoke with told her to look at the guidelines for BCBS of IL for the requirements. I had also been told that until I told the rep that I am a federal employee and it's not the same as the state plan. (FYI when you look at all the other health ins brochures like Aetna and GEHA it specifically states that a pre-op diet is required,BC does not have that listed). She finally asked a supervisor who informed her that I was correct and they were only looking for BMI and co-morbids. But I'm still a bit nervous b/c my surgeon's office was given wrong info. And it's funny too b/c when I met the surgeon and he asked about my insurance he perked up when I told him I had federal BC; he said that they are the easiest to get approved and only require the BMI and comorbids. By the way my BMI is 41 and I have diabetes and high cholesterol.
I have experience with this as I used to work for a major insurance company in the UM/precert department. I'm familiar with the entire process but not as a federal employee with BCBS. My info was submitted on Wednesday morning and we're waiting to hear back (it's for lap RNY). If anyone out there is a federal employee I could use some of their personal experiences for comfort.
Thanks in advance!!!!!
Daisy
Daisy,
I have BCBS Federal and I am understanding that untill January 1st you dont have to do the 6 month supervised diet. After January 1st of 09 you have to be pre certed and do the 6 month diet. I only know this cause I had to call BCBS about going to a gastric bypass doc here in Florida and they thought I was wanting the beginning of surgery. I had my surgery 6 years ago.
So hopefully you can get your surgery done before the 1st of the year.
Carla
I have BCBS Federal and I am understanding that untill January 1st you dont have to do the 6 month supervised diet. After January 1st of 09 you have to be pre certed and do the 6 month diet. I only know this cause I had to call BCBS about going to a gastric bypass doc here in Florida and they thought I was wanting the beginning of surgery. I had my surgery 6 years ago.
So hopefully you can get your surgery done before the 1st of the year.
Carla
I have BCBS Federal and live in Illinois. I just had lap RNY done in August. I had to have a documented 5 year history of obesity; a bmi of over 40 with no comorbidities or 35 with and a very well documented 6 month medically supervised diet.
What I experienced when I called the toll free number on the back of the card is that I never got the same answer twice. I always asked for everything in writing- I would always tell them if they get documentation, so should I. (that is the government employee in me.)
I don't know if this is the answer you wanted--but this is what I had to have. I hope it helps, Good luck in your journey.
--teri
What I experienced when I called the toll free number on the back of the card is that I never got the same answer twice. I always asked for everything in writing- I would always tell them if they get documentation, so should I. (that is the government employee in me.)
I don't know if this is the answer you wanted--but this is what I had to have. I hope it helps, Good luck in your journey.
--teri
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