Question:
Does anyone have any current information on getting WLS with BCBS Federal?

From what I can tell, there hasn't been much posted recently about the Federal BCBS plan (11-2002). Can anyone share any information they have about the precertification process and any roadblocks they might have hit? Does BCBS Federal still not precertify as noted in earlier posts? It is in the plan book that they will cover WLS as long as the patient is at least 100 lbs. or more over weight.    — Lana R. (posted on November 27, 2002)

November 28, 2002
I have fed bcbs. They pay for quite a bit! They paid NOTHING; however, on the first visit. If you have all your deductibles, and you are pre registered, your hospital bill should only be $100. I didn't put all this info on my profile yet, I am 2 months post op and not sure all the bills are in yet, I plan on doing this in the next week or two. So check my profile then, or e-mail me if you have any more questions. [email protected]
   — Tammy .

November 28, 2002
I currently have Federal BCBS and was told by BCBS that they would not do a preapprove and to go ahead and have the surgery and then they would make their decision on what they would pay. My surgeon's office even called BCBS because they couldn't believe that any insurance would say that when it is a minimum of $30,000 for the procedure. BCBS told them the same thing. It is currently open season for Federal Employees so I am switching to Mailhandlers, who assured me that I was qualified and they would approve my surgery without a second thought. GOODLUCK!
   — C. Zibrowski

November 28, 2002
Hi - I have FEP BCBS and am having surgery 12-5-02 Open RNY. I went through a MAJOR panic attack because I found out the same thing you did. One surgeon I went to said he'd waive his upfront fee for me BUT the Anesthesia group made me pay their fee upfront and the hospital was REQUIRING me to pay $13,500 upfront before I set for in the hospital. THIS WAS VERY DISCOURAGING. I switched surgeons and found a WONDERFUL man who talked to the hospital and got the fee waived. He also didn't require me to pay his fee upfront either. Incidentally, this surgery is a COVERED benefit and that is why FEP BCBS doesn't preauthorize. They will pre-certify but that doesn't mean anything to the hospital or doctors. If you meet their requirements then you should be fine. I'll find out soon I guess. I only have aches/pains as a co-morbidity and am 100-lbs overweight. FEP BCBS doesn't preauthorize ANY surgery. I just had a hysterectomy in June and they paid out wonderfully. All I am paying when I go for my WLS is $100 for the hospital...I've met my deductibles for the year and that is why I was wanting the surgery before the end of the year because I had paid it in. Feel free to contact me if you'd like.
   — Debra L. H.

November 29, 2002
The Federal BCBC Plan (especially of Georgia), can be discouraging. Almost make you hate working for the government entity. I was soo excited when I found out BCBS of GA paid for this surgery (providing you have ALL of the requested information, etc). Had LAP RNY-proximal on 9/3/02,~my total bill for the hospital was $34,000+, the total for my surgeons was 17,000+ ...I don't have all of the particulars with me right now, but email me, and I'll give you all of this information. I think one of the reasons I had such I high bill for all concerned is because I went out of network and had some complications (not related to the WLS). I was not at all pleased...I knew that I would have to deal with a good portion of my bill, but NEVER expected that I would end up paying $21,000 (and that's just for the hospital, we haven't even totalled the other parts yet, mind you). We (federal employees) pay 3 arms and 5 legs per month for this supposed *excellent coverage*, only to be left with monumental medical bills...I am going to try to work out a payment plan, but if they don't settle for that, then bankruptcy may be another option. I feel better physically, and I may just have to get a second job to take care of this obligation~we're doing the best we can right now...my DH is working 2 full-time jobs. Precertification is not required anymore, but be safe and check anyway. They can be so wishy-washy and different customer service representatives will tell you different things. There is a whole list of things I had prepared before I even thought about Federal BCBS insurance. I researched the WLS for about 3 years and wanted to make sure I had all of my duck in a row-yeah, they approved me, but didn't pay enough as far as I'm concerned. If you can DO NOT go out of the network for the surgeon, you will have to pay more. I only chose to go out of the network because I chose Dr. J.K. Champion. To me, no one can compare with his expertise. Don't regret going to him AT ALL-my displeasure is with my insurance plan. Someone from BCBS told me what to do next with regard to the large amount that wasn't paid and I'll be taking some necessary steps within the next month or so. Don't just stop at being at least 100 lbs overweight, there's more to it than that...Remind me to tell you~~Sincerely, "Yourdivaness"
   — yourdivaness

November 29, 2002
I have BCBS Federal and had open RNY 9-10-02. I followed their rules for pre-certification and had no problems. Call them and they will tell you exactly what you need. They paid for all pre-tests including the pysch exam. Took about three weeks and they sent a letter of approval for in-patient surgery. Am currently down 52 lbs. Yeah!
   — Mimi R.

November 29, 2002
Hadiyah - your insurance plans - as well as all insurance plans - spell out what the financial penalties (in the form of increased subscriber obligations) are incurred by going to an out-of-network doctor. And, as you say, it was your choice to go to an out-of-network doctor. To rip your insurance company for following the guidelines which you were fully aware of is uncalled for. <p> I went to an excellent bariatric surgeon & hospital who accepted my insurance (Aetna US Healthcare) - all I had to pay was $200 for my nutritional consult, $200 for my psych consult and $10 for my co-pay for my initial consult with the surgeon. Starting with my 6 month visit in January and subsequent follow-up visits with my surgeon, I will also have to pay a $15 co-pay (AetnaUSHC is bumping up our specialists' co-pay $5 starting in January 2003). <p> So, for any pre-ops out there who are choosing to go out-of-network for your surgeon and/or hospital, please review your medical insurance benefits book to find out exactly what you are obligated to pay for this choice before you find yourself tens of thousands of dollars in debt. If you can find an in-network surgeon and hospital that you feel comfortable with, so much the better. WLS does not necessarily have to mean financial ruin...JR
   — John Rushton

November 29, 2002
You have a lot of different responses to this and I am wondering if all federal bc/bs is the same. I have federal Carefirst bc/bs and I'm in the Washington, DC metro area. My plan book says the same as you do. They will pay if the person is at least 100 pounds overweight. My insurance still does not preapprove anything which is has become a bit problemsome with finding a doctor to do plastic surgery on me, but I had no problems with my weight loss surgeon doctor because they were familiar with that insurance. I didn't do anything and the doctor's office didn't do anything but submit everything to them after my surgery. They paid.
   — Lisa N M.

November 30, 2002
I have BCBS Fed PPO and had surgery 7/5/02. They did not pre-approve as everyone is mentioning here. I had to pay the 10% co-pay to the surgeon before surgery but nothing else to anyone else (except $15 office visits, etc.). All bills have now been submitted and paid. The only problem areas were that I had to call on almost every bill submitted and ask that it be resubmitted. They denied the hosptial bill, surgeon's bill, anesthesia bill, pathology, etc. the first time through. However, none had to be "appealed" per say, they just sent them back through and all have now been paid. The only other problem I have is that BCBS refuses (apparently) to pay for LAP procedure, will only pay the OPEN rate. Difference in my case is $8000. Surgeon's office told me they would not bill me for the difference and my EOB shows I'm not responsible for the difference in billed amount and negotiated savings. However, I just received a bill from the surgeon for $7300+. Haven't decided how to handle that yet, but I'm not planning on paying it.....
   — jutymo