Federal Blue Cross update

I just received a call from my doctor's office today that I am approved!  When I spoke with someone at BC a couple of weeks ago, she said that they don't pre-approve the surgery,  but the dr's office said that this is indeed an approval letter and that you just have to push and know how to talk to them.  The downside is that they will not cover the sleeve procedure.  The office also said that since I'm approved that I don't have to have a full psych consult.  I did have to have the 5 year history (no problem) and the 6 month diet history.  In the 6 months I saw either my dietician or my internist each month and that apparenlty satisfied this requirement.  (BC only pays for 4 dietician visits per year).   Anyone else who has BC Federal (I have the Standard option) please keep us posted on your progress and/or experience with them and I'll do the same.

Wow!!  Congratulations on your approval!!  I'm still doing the dietician/psych/blood work tests.  How long was it after they sent the paperwork to BCBS before you found out you were approved?  Keep your fingers crossed for me!!

I spoke to someone at BC yesterday and she said that the letter was not an approval letter, but again that it wouldn't be approved until after the surgery.  I asked about an approval for the hospital stay and she said that they would do that when the surgery was scheduled and that if the stay was approved, that was a good sign that the claim would go through.   Also, my doctor's office told me that I didn't need to keep my full pysch eval appointment next week as the insurance "had already approved the procedure", but the lady at BC advised me to keep the appt as lack of documentation of a psych eval was what held up most approvals.   I'm not sure of the timeline, but it was probably 3 weeks or less.  I will keep my psych appt next week and then I have an appointment on 7/23 with a new surgeon as mine (who I knew from working with his as a resident and liked) apparently left the practice.  I hope to have the surgery in August, so I'll let you know how things progress and will keep my fingers crossed for you.

Hi,  I am new and am considering the lap band procedure.  I have federal BCBS also.  Do you have to pay anything upfront for your surgery?  If I understand the insurance brochure correctly, BCBS will only pay 90%.  Is that right? Thanks, Janet

I believe it depends on if you have Standard or Basic.  Consult the website (fepblue.org) or call Blue Cross and get that information.  Everyone that I've spoken to at BC has been very helpful.  For an in-patient procedure (RNY), the standard plan pays 90% of the physician (surgeon, surgeon asst, pathologist, radiologist, etc.) and I have a $100 co-pay for a hospital stay (I just had a hyst in March and this is how they paid).  You have to pay 10% of the ALLOWED charges, which is considerably less than what providers bill the insurance for.  Of course this is after you've met your deductible.   I also double check to make sure that the hospital, physicians, assistants, anesthesia, etc. are all preferred providers.  I've never had day surgery with Federal BC, so I don't know the co-pay on that.  Good luck.

I also have BC/BS fep but I don't have 5 years of history, only 3 but I do have co-morbidities. Anyone over come this problem?