BCBS FEPs

Hi!  I am considering WLS - have a meeting with the surgeon 11/23 (after stuffing myself with turkey?).  I have BCBS Fep (federal employee plan).  First, I am overseas so I can go to any one I want and pay up front.  I then send in my receipts for reimbursement.  So I called BCBS to see what I needed to do to get pre-approved for the surgery.  They told me that they do not pre-approve in this situation, that I just apply for reimbursement once I have completed the surgery.  Now, that sounds too easy!! In the policy they cover BMIs over 40 (I am 42) or over 35 with co-morbidities.  If that is all that is stated in the policy, is that all I have to 'prove'????  No word on 6 months of diet, etc. ANyone else have BCBS feps (bonus points for those that are overseas, as well!) Thanks!! Kari

They cover without issues.  All you really need to have is the BMI over 40 and co-morbidities.  Now stateside, you do have to have the Nutrition Consult, Psyc. Eval, and the Doctors recommendations.  I am already approved all I need to do is send in the info.  They are really easy to deal with.  Approval is also fast.  You should be fine as long as you do everything according to there standards and submit it.  I have worked overseas, but did not really have to go through any major claim process.  As long as they get what they need you should be good.  It really is as easy as it sounds....providing you meet there qualifications.

 

 

Sounds right, but keep copies of all they send you and notes of who you speak with just in case you run into any bumps.  And congrats.

Hi! I too have BCBS FEP. Approval was easy. No six month diet - only a BMI that qualifies and proof of being this weight for at least 5 years and some documentation on previous dieting attempts. Also, my surgeon had to send in a letter of Medical Necessity. Once approval came through my surgeon's office requested an Ultrasound, Pulmonary Visit, and Psychologist approval. The Pulmonologist sent me for a sleep study and stress test. My surgery has been scheduled for 11/8 and all I have to do is pre-op testing (EKG, Xray, etc). Others on this board say that our plan is one of the easiet to deal with.  Good Luck!