Question:
Anyone familiar with critieria to meet with Blue Cross/Blue Shield fedreal?

Hi, I am unsure off all the criteria to meet for blue cross/blue shield federal? I am in Louisiana...but would like any help.....I am praying for an approval...when I submit all my paper work, Thanks    — trstears (posted on May 19, 2005)

May 19, 2005
Hi there! I am a Federal employee in the Seattle area. I had BC/BS last year. They have six requirements, and if you call the customer service line they can direct you to the link on their website. Basically, if memory serves me correctly, BMI over 40/or 100lbs or more overweight, history of attempted weight loss, including 6 months medically supervised, over age 18, etc. BUT, here is the kicker- they do not pre-authorize the surgery. It is covered, but you do not have the peace of mind going into surgery that your claim will be approved. I ended up researching ALL the Federal health plan options and selected GEHA during open season. I was approved quickly (less than two weeks) and have been very pleased with this healh plan. Good luck with your weight loss journey!
   — Lori H.

May 19, 2005
I also have federal BCBS.. the criteria are as stated below and again you have no approval papers.. But mine did cover 80/20 minus deduct. and all of hospital minus deductable. Good luck and God bless.
   — Vitabella

May 20, 2005
They wouldn't preapprove me either. The only good thing was no waiting for an approval. The office scheduled it and I had surgery. The scary part was that I got denied because they called it cosmetic. After some paperwork they did pay after I proved it to them that I met the criteria--over 100lbs. overweight and that it was medically necessary. I would like to know how well they pay for plastics. I don't think they preapprove that either. That might be too risky for me.
   — Kim N.

May 20, 2005
I have BC/BS Federal and the only requirement was that I had to be 100 pounds overweight. They do not preapprove but my doctor's office said they had never turned any of their patients down. They paid for my bypass and since my policy states that plastic surgery can be approved if it is needed as a "result of a surgery", they also approved my tummy tuck. My only out of pocket expenses were $100 dollars a day for each day I was in the hospital. So, out of approximately $100,00 dollars worth of surgery, I was only out $500.
   — CAMFR

May 20, 2005
I, too, have BCBS-Federal. As stated previously, they don't pre-approve, but my doctor's office was confident they would pay. I was over 100 pounds overweight but had no other co-morbidities. I was a little worried! I had my surgery in January and BCBS just paid my hospital bill this week. I was out $100 for my total 3 day hospital stay. But don't count on pre-approval...they don't do it.
   — karenisahogfan