Question:
Please help! Federal Govt. employees
I have just been told by Federal BC/BS that they do not preauthorize any surgery, that you just have to have it and basically hope that they will pay. They say if it is medically necessary then there shouldn't be a problem. Well, we all know that isn't necessarily the way things are done with WLS. Can any of you tell me if you have BC BS federal and had surgery and they denied payment? I was told by BC BS that all federal plans are like that. Are there any of you that have other federal health insurance that can share your experiences with me? I just found this out and open season closes Monday so I am in a bind trying to figure out what to do. Thanks for your help. — Connie B. (posted on December 7, 2001)
December 7, 2001
connie i have fed bc/bs. i was told the same thing u were but was also told
they will pay the bill cause they always do as long as u use a preferred dr
& hospital. my surgeon is preferred & his girl said they get paid
everytime. so, if u stick to the guidelines im sure u wont have any
problems with payment. good luck.
— sheryl titone
December 7, 2001
Hi Connie, I have BCBS Federal employees also and I was WORRIED before
surgery, but they paid without a problem. They did want me to be at least
100 lbs overweight (per my policy book). I have never had a problem with
then denying anything associated with the WLS. Keeping my fingers crossed
for my tummy tuck next year. Good Luck!!!!
— Debbie M.
December 7, 2001
I am a fed employee with Compcare Blue, an HMO of BCBS. I was preapproved
so not all plans are the same. If my surgery isn't done as scheduled Dec
14, I will have BCBS and hope what you said isn't true in Wisconsin.
Different states have different rules even though we are under federal
plans.
— Jane Wurzel
December 7, 2001
I am a retired Federal Employee (USPS) and I have Lovelace and they are
going to only pay 50% and have authorized one day in the hospital and on an
as needed basis. I can see right not I am going to have a fight on my
hands to get them to pay the other 50%. They call morbid obesity surgery
"cosmetic". Any suggestions. I have severe sleep apnea.
— Kathryn K.
December 7, 2001
kathryn i am going to take an educated guess here so bear with me. if i am
not mistaken lovelace is NOT a government wide federal plan. i believe they
r either on the order of an hmo or actually r an hmo. they r governed by
the state u r in, as is bc/bs fed govt wide, but, the federal govt is the
last say in its policies. the state run agency submits its plan to the fed
govt for approval & rights to offer its benefits to the federal
employees in there particular state. in essence, the federal govt is giving
the state run agency their stamp of approval to run its benefits as they
see fit. u, therefore, r treated as all of lovelaces patients r treated no
matter what agency u get ur insurance from. i hope i am not confusing u. it
is open season still, i believe. u might want to look into switching ur
insurance to a more wls friendly company eg: aetna or bc/bs. good luck to
u.
— sheryl titone
December 8, 2001
I have BC/BS Federal - you're right - they don't pre-approve. But, they do
pay....my surgeon has dealt with them tons of times and he says they have
never failed to pay on anyone....I also did not have to have any of that
pre-surgery stuff with psychiatrists and nutritionists that some plans
require....
— Cathy J.
December 9, 2001
Well, not ALL federal plans are like that. I have Mail Handlers & they
pre-authorized my surgery & paid according to the plan benefits: 70% to
a non-PPo provider, 90% to PPO provider & they paid 100% of my PPO
hospital bill with no deductible. I didn't have to have the psychiatric
eval or submit proof of previous weight loss attempts. I was quite
satisfied with how they paid & handled my surgery. Now, if I can only
get them to approve my plastic surgery.....
— Kathy W.
December 10, 2001
If you have a medical necessity for the surgery (co morbidites) it should
not be a problem
I have BC/BS FEP and they approved me in 2 weeks back in '94. Now with no
preapproval, as long
as it is documented for medical necessity, you will be covered. My tummy
tuck was
covered with no problem either. Just documented the medical necessity....
— vt_rita
December 11, 2001
Dear Connie,
Many doctors take BCBS Fed with no problem. If you meet the 100 lbs
requirement you should be fine. I have mail handlers insurance and they
approve before surgery. I didn't like the way BCBS refuses to give a
"pre-determination" approval before surgery so I changed to mail
handlers.
— Carmen K.
December 17, 2001
I have BC/BS of AZ FEP -- I have my consult on the 28th, and hope to have
the surgery in Feb. or March. Both the surgeon and the hospital are
members, so that should be ok. I just hope they approve me -- I'm over 125
lbs. overweight, have sleep apnea, back surgery, asthma, borderline blood
pressure and MS. I'll let you know. Has anyone else dealt with BC/BS of
AZ FEP?
— Alyce G.
Click Here to Return