Re: Federal Blue Cross Problem- GOBO

[Guest guest]

I had my DS in November last year. I had BC/BS standard option

(Federal). They would not precertify the surgery, but they did

precertify the hospital stay. Make sure the hospital has a precert #

BEFORE you are admitted. I live in NC and had some pre-op tests done

here. My surgery was in Ga. and BC/BS Ga. handled those claims. BC/BS

paid for all my pre-op tests, including a portion of my psyc eval.

They paid 100% of the hospital stay except for a $45 charge for a

private room. They paid 90% of my surgeon's fee (he was in network)

although the negotiated fee was rediculously low. They only paid 75%

of my anesthesiologist's fee, which is what standard option specifies.

I'm sure high option has a better schedule. I had no problems at all,

although I was afraid I would. They have paid for many DS procedures,

don't worry. My surgeon used code 43847. If I can answer any specific

questions, email me directly.

> I just discovered something that is upsetting.

> I have Federal Blue Cross - High Option. I thought this was the

> 'Rolls Royce' of Insurance Policies but now I'm not so sure.

>

> Federal Blue Cross no longer pre-approves or certifies for

> treatment. Their position is that they will not look at a bill until

> the whole thing is over. As long as the patient met the criterium

> for MEDICAL NECESSITY, there is no problem. This, however, is

> not what has me worried.

>

> Blue Cross ONLY covers Bariatric Surgery for Gastric Bypass

> and Gastric Stapling. They do not specifically 'exclude' the

> DuodenalSwitch but when I asked about it specifically, they said

> it would be denied. I'm not clear on exactly what 'gastric bypass'

> means. I thought it was the generic term for ANY Bariatric

> Surgery. Please educate me. ;-}

>

> I looked on AMOS and only found one incidence of Federal Blue

> Cross paying for the DS/Switch. However, it was a year ago

> when they still did pre-certifications and the surgeon was Dr.

> Welker who could practically walk on water when it comes to

> convincing insurance companies to pay.

>

> I want to know as much as possible what EVERY other Federal

> Blue Cross subscriber's experience has been. The Office of

> Personnel Management told me how to 'arm' myself in advance.

> They said that the more cases I can cite where Federal Blue

> Cross ended up paying for the DS/Switch, the better I am. They

> said that all these other cases will be setting a precedent.

>

> Please let me know what your Federal Blue Cross experience

> has been, I NEED to know. You can email me privately if you

> prefer.

>

> Thanks so much in advance.

>

> gobo

[Guest guest]

;

You Are A Saint!!! ;-}

Private email to follow.

gobo

> > I just discovered something that is upsetting.

> > I have Federal Blue Cross - High Option. I thought this was

the

> > 'Rolls Royce' of Insurance Policies but now I'm not so sure.

> >

> > Federal Blue Cross no longer pre-approves or certifies for

> > treatment. Their position is that they will not look at a bill until

> > the whole thing is over. As long as the patient met the

criterium

> > for MEDICAL NECESSITY, there is no problem. This,

however, is

> > not what has me worried.

> >

> > Blue Cross ONLY covers Bariatric Surgery for Gastric Bypass

> > and Gastric Stapling. They do not specifically 'exclude' the

> > DuodenalSwitch but when I asked about it specifically, they

said

> > it would be denied. I'm not clear on exactly what 'gastric

bypass'

> > means. I thought it was the generic term for ANY Bariatric

> > Surgery. Please educate me. ;-}

> >

> > I looked on AMOS and only found one incidence of Federal

Blue

> > Cross paying for the DS/Switch. However, it was a year ago

> > when they still did pre-certifications and the surgeon was Dr.

> > Welker who could practically walk on water when it comes to

> > convincing insurance companies to pay.

> >

> > I want to know as much as possible what EVERY other

Federal

> > Blue Cross subscriber's experience has been. The Office of

> > Personnel Management told me how to 'arm' myself in

advance.

> > They said that the more cases I can cite where Federal Blue

> > Cross ended up paying for the DS/Switch, the better I am.

They

> > said that all these other cases will be setting a precedent.

> >

> > Please let me know what your Federal Blue Cross

experience

> > has been, I NEED to know. You can email me privately if you

> > prefer.

> >

> > Thanks so much in advance.

> >

> > gobo

[Guest guest]

;

You Are A Saint!!! ;-}

Private email to follow.

gobo

> > I just discovered something that is upsetting.

> > I have Federal Blue Cross - High Option. I thought this was

the

> > 'Rolls Royce' of Insurance Policies but now I'm not so sure.

> >

> > Federal Blue Cross no longer pre-approves or certifies for

> > treatment. Their position is that they will not look at a bill until

> > the whole thing is over. As long as the patient met the

criterium

> > for MEDICAL NECESSITY, there is no problem. This,

however, is

> > not what has me worried.

> >

> > Blue Cross ONLY covers Bariatric Surgery for Gastric Bypass

> > and Gastric Stapling. They do not specifically 'exclude' the

> > DuodenalSwitch but when I asked about it specifically, they

said

> > it would be denied. I'm not clear on exactly what 'gastric

bypass'

> > means. I thought it was the generic term for ANY Bariatric

> > Surgery. Please educate me. ;-}

> >

> > I looked on AMOS and only found one incidence of Federal

Blue

> > Cross paying for the DS/Switch. However, it was a year ago

> > when they still did pre-certifications and the surgeon was Dr.

> > Welker who could practically walk on water when it comes to

> > convincing insurance companies to pay.

> >

> > I want to know as much as possible what EVERY other

Federal

> > Blue Cross subscriber's experience has been. The Office of

> > Personnel Management told me how to 'arm' myself in

advance.

> > They said that the more cases I can cite where Federal Blue

> > Cross ended up paying for the DS/Switch, the better I am.

They

> > said that all these other cases will be setting a precedent.

> >

> > Please let me know what your Federal Blue Cross

experience

> > has been, I NEED to know. You can email me privately if you

> > prefer.

> >

> > Thanks so much in advance.

> >

> > gobo

[Guest guest]

;

You Are A Saint!!! ;-}

Private email to follow.

gobo

> > I just discovered something that is upsetting.

> > I have Federal Blue Cross - High Option. I thought this was

the

> > 'Rolls Royce' of Insurance Policies but now I'm not so sure.

> >

> > Federal Blue Cross no longer pre-approves or certifies for

> > treatment. Their position is that they will not look at a bill until

> > the whole thing is over. As long as the patient met the

criterium

> > for MEDICAL NECESSITY, there is no problem. This,

however, is

> > not what has me worried.

> >

> > Blue Cross ONLY covers Bariatric Surgery for Gastric Bypass

> > and Gastric Stapling. They do not specifically 'exclude' the

> > DuodenalSwitch but when I asked about it specifically, they

said

> > it would be denied. I'm not clear on exactly what 'gastric

bypass'

> > means. I thought it was the generic term for ANY Bariatric

> > Surgery. Please educate me. ;-}

> >

> > I looked on AMOS and only found one incidence of Federal

Blue

> > Cross paying for the DS/Switch. However, it was a year ago

> > when they still did pre-certifications and the surgeon was Dr.

> > Welker who could practically walk on water when it comes to

> > convincing insurance companies to pay.

> >

> > I want to know as much as possible what EVERY other

Federal

> > Blue Cross subscriber's experience has been. The Office of

> > Personnel Management told me how to 'arm' myself in

advance.

> > They said that the more cases I can cite where Federal Blue

> > Cross ended up paying for the DS/Switch, the better I am.

They

> > said that all these other cases will be setting a precedent.

> >

> > Please let me know what your Federal Blue Cross

experience

> > has been, I NEED to know. You can email me privately if you

> > prefer.

> >

> > Thanks so much in advance.

> >

> > gobo