Federal Blue Cross Problem

[Guest guest]

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