Problem with BC/BS Fed Program

I got a call from my Surgeon on Monday  telling me that my surgery  (as well as others) was cancelled due to changes in criteria by Blue Cross Blue Sheild Fed. They  require a list of  medical crieria that has to be met before you can be approved for surgery.  There was no way  to have everything done in time to met my  surgery  date of Feb 04. So now I have to wait  until my surgeon can see if I am in compliance with the NEW guidlines.  This so unfair to anyone using BC/BS for healthcare. A firiend of mine had her  lapband done last year without any problem. Has anyone experinced this problem with BC/BS?

Hi Addie

I'm so sorry for your cancellation.  I know that must be frustrating. I guess you didn't see the rule changes during the last "open season"  (ended in Nov?).    I think the main change is you have to go through a 6 month supervised weight loss.  have you called BCBS yourself & ask if you can appeal their decision?  Even though they made a few changes, you might already have met the requirements.

www.fepblue.org will give you the new rules...around page 55 or 56 I think. 

Hang in there!

Nope, I didn't see the rule changes. I spoke with a Rep for BC/BS in regards to my switching to them and the surgery and there was no mention of any NEW changes. You would think that they would have known at the time. Anyway, I guess it's another delay in things for me. But I won't give-up.

My surgery was last May.  I was covered by BC/BS FEP program. I did 6 months of dr/nutrition visits and was covered.  One thing to watch out for - I have had to pay over $100 everytime I go in for a fill (which was often at the beginning)

I have already met some of the new compliance's they are asking for, i previously attempted to have the surgery thru AETNA, who wanted too much of a "co-pay" of $1300-1800 for the same surgery. I should be good to go with my surgery but I don't like delays, I am not a patient person.

I have BC/BS and had surgery on 11/9. They covered everything, but it took about one year to go through the "process" including psych eval, support groups, etc.....

Im on FEP Blue and had my surgery with no complications, didnt have to any requirements to comply with but I know that the changed the rules for 2011.  The only thing that you can really do is call and see if you can appeal or see if you have already met most of the requirements already.

Sorry that you are having trouble. I am on Humana FED and had no problems, but a coworker just had her band in November 2010 and things went smoothly. She did mention that AFTER all was said and done, in the bill her Band was listed as a Durable Medical Device, which added something like $1000 she had not expected. I will ask her to come over and post with the specifics because I do not know them, but I just thought it was something you might want to ask about since I was not charged that way and I don't know if it is something they mention if you don't ask about it.

Also be aware that BS/BC limit the amount of fills they pay for. It was 4 fill limit for me and the rest are self pays. So verify that with your surgeon's office too.

I also have Bc/bs fed insurance.  I went through all the dr appts, and the paper work was sent to the insurance co.  I received a letter from them stating that I could go ahead and have the surgery and then they would decide if they would pay for it.  After many calls to the insurnce co, I went online and found a web site listing all the insurance co's and their CEO's and addresses.  I sent a registered letter to the CEO of bc/bs.  After waiting for several weeks, with no answer, I was ready to head to Chicago and speak to the prople in person.  That after noon, I received a phone call from the insurance co, stating that they approved my surgery.  A couple of days later, I received a letter from the vice-president of federal bc/bs stating that they were sorry I had so much trouble getting approved, and that they will start listening to the dr's stating if a patient needed this surgery, they should approve it.