Question:
Does BC/BS Federal cover a second surgery

I just found out I do have a staple line disruption after having an upper GI. I go for an endoscope in January and my surgeon said there's a possibility of a second surgery to fix my problem. Has anyone with BC/BS Federal had a second surgery and did they pay for it? I do have pain in my tummy, especially when I bend and have had acid reflux since there's the leak. Any info would be appreciated. Thanks, Victoria    — VickyTaylor (posted on December 28, 2001)

December 28, 2001
It's a repair... so I imagine that they WOULD cover it.
   — LAK

December 28, 2001
i imagine that this would be a necessary surgery, so, why shouldnt bc fed cover it? give them a call. i have always found them to be very helpful.
   — sheryl titone

December 29, 2001
My experience with Federal BC/BS (20 years of it) is coverage has always been determined by the question of "medical necessity". If the surgery is considered necessary, normally they pay with no problem.<P> I recommend that you call you local office and verify that the surgery will be covered and find out what you will be required to pay. <p>There are a lot of changes for the 2002 benefit year. My understanding is that if you have the "standard" option, you will end up with a lot more out-of-pocket expenses than in previous years. If you have the "low" option, you must go to an in-network provider (doctor and hospital) or they won't pay anything. <p> Verify with your doctor that the second surgery is "medically necessary". You may want to ask what the charge will be for it and whether he/she is an "in-network" provider. Then take the time to call and ask the questions before the surgery so you don't have any surprises. Good Luck.
   — [Anonymous]

December 29, 2001
I don't have this insurance presently, but many in my area do. Aside from specific restrictions, many have had their revisions covered, more than one revision. I'm sure there have to be some qualifiers, but yes, I've seen several covered.
   — vitalady