Question:
Does any one have Federal BCBS PPO (NYS)?
I live in New York State, and I have BCBS PPO- Federal Employees insurance. My surgery date has been scheduled for 11/20/06 and I fit the criteria for WLS. The only thing is that I have not been on a medically supervised diet in over a year. I have called my insurance company (four times) to see if they require this information and they said no, all they need is a letter of medical necessity. Should I be worried? — Kay_dee (posted on August 5, 2006)
August 5, 2006
I had my surgery four months ago after being assured by the company that
"medical necessity" would be shown by the chart notes from my
doctor(s). Well, it took three months of examing my file for the company
to decide to pay my surgeon. The decision on the very large
hospital/anesthesiology bill has yet to be made. It has turned into quite
a hassle, but I'm confident that I qualified for the surgery, it is a
covered item, and all my medical professionals have told me that BCBS is
notoriously slow at
making payment, but will eventually. Just make sure that all your doctors
note everything that you tell them about how morbid obesity has negatively
affected your life. Good luck -
— Woodland
August 5, 2006
Insurance contracts are different from company to company. A BCBS PPO
contract for a private company is different from what is contracted with
the Federal Government. My partner did it with Mail Handlers Federal
Employee insurance and they didn't give her a hard time about the surgery.
She got approved, had all her tests and in October it will be three years.
Looks like you and I will be having our surgeries weeks from each other.
Congratulations.
— the7thdean
August 5, 2006
Hi! I live in Alabama and also have BCBS Federal PPO and I had my surgery
Feb.23, 2006 and my insurance covered it. I DID have to have 6 months
supervised diet and non-smoker, and be 100 lbs overweight. I met all of
those. The insurance paid all but about $500 of the surgery. Hope all goes
well for you. E-mail me if you need to ask me another question. ~Melissa
— WannaBSlim
August 5, 2006
Hi! I live in Alabama and also have BCBS Federal PPO and I had my surgery
Feb.23, 2006 and my insurance covered it. I DID have to have 6 months
supervised diet and non-smoker, and be 100 lbs overweight. I met all of
those. The insurance paid all but about $500 of the surgery. Hope all goes
well for you. E-mail me if you need to ask me another question. ~Melissa
— WannaBSlim
August 5, 2006
I would think if they've told you four times that it's not required that
it's likely not required. I would call and ask them to put it in writing,
or better yet, to send you a written pre-approval for the surgery. Most
surgeons require this anyway. Good luck.
— psychobabble35
August 6, 2006
I have FED BCBS and my WLS was covered. You should have no problem. If you
have a BMI over 40, then u should be good. I only had to give a detail
list of attempt diets. My weightloss attemps were not medically supervise.
WW count, which I had done. I was approved in less than 2 weeks with no
effort of my own.. Surgeon office handle everything.
— Just P
August 6, 2006
I had surgery in May of 2005 (Lap RNY). I didn't have to submit any proof
of diets, etc. (Unless the Surgeon's office did it based on what I told
them.) I actually changed to BCBS in anticipation of the surgery as I
understood that they were the easiest to get approval from. In fact, the
surgery was "pre-approved". After surgery, only THEN did the
surgeon submit the medical necessity letter to receive insurance proceeds.
I found that a "mixed bag". I was very happy that the approval
process was relatively easy, but on the other hand, I wondered if that also
made it possible for them to deny it AFTER the fact and leave me with a
sizeable bill! I ended up calling my insurance plan several times and
asking as many questions as I could, noting the date, time AND the name of
the person I spoke with as well as what they said. I got the procedure
codes from the surgeon's office for the Lap RNY, for an "Open"
procedure if it was necessary for them to change mid-operation, etc., and
ran those codes by the insurance people. ("What would happen
if...") As it turned out, the claim was paid fairly quickly (both
Surgeon AND Hospital), with the exception of my co-pay. I'm in Michigan, so
some of that might differ from NY (although you'd think that a Federal Plan
would be uniform throughout the country, I'v heard an occasional story that
would seem to indicate otherwise!) Don't know if that helps at all, but
Good Luck with the surgery!! Chip
— Chip Locke
August 6, 2006
Hi, My name is Ginny and I live in Indiana and I have BCBS Federal and I
had no trouble getting approved. I lost all my WW records and they
couldn't find them after calling to prove that I had become a lifetime
member and I did Opti-fast for a year through a hospital program and it had
been 10-15 years ago and no one saved any records so I had no record of
that either but they approved me for surgery right away after they got
records from the surgeons office. I don't think you have anything to worry
about. You'll get your approval.
— Virginia M.
August 7, 2006
Thanks you all for your responses, my mind is at ease. I will post my
outcome on my profile page, when I receive my approval. Thanks again!
— Kay_dee
August 7, 2006
I have the same insurance. Don't be worried! I called and there are no
requirments if you meet the criteria. In fact, they told me I didn't have
to have pre-approval!
— Nichole27
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