Re: Has Anyone Had the FEDERAL EMPLOYEES Program Insurance Paid for their BPD/DS

[Guest guest]

> Dear Group,

> I have the Federal Employees Program of BC/BS. When my

surgeon's

> office sent in my insurance info last week, they were told (over

the

> phone) that BC/BS no longer does preapproves for surgery.

They said

> just to go ahead and have the surgery, and they would decide

> afterwards whether to pay for it or not.

>

> Meanwhile, my surgeon's office wants me to sign a promisory

note

> before surgery, stating that I will be financially responsible for

> the entire bill AND PAY THE ENTIRE AMOUNT IMMEDIATELY

UPON DENIAL,

Beth;

I have Federal Blue Cross- High Option.

I just had my surgery 2 weeks ago and research the matter in

great detail .

DO NOT SIGN ANY PROMISSORY NOTE!

I would run, not walk from any surgeon trying to get you to sign

such an agreement.

Blue Cross explained to me that to do so is to create an

agreement that is solely between you and your surgeon. They

also said that this creates a contract which drops Blue Cross out

of the equation.

Blue Cross even has it in their policy, in black and white,

advising people to not get into a written agreement with a

surgeon for anything.

Further, it is in the policy (again, in black and white), that

bariatric

surgery is a covered benefit.

My surgeon calls it the Distal Gastric Bypass instead of the

BPD/DS. Apparently, that is more palatable to the insurance

companies.

Federal Blue Cross has changed their policy regarding approval

to be consistent with Medicare. Medicare happens to have one of

the best pay records of all; they simply do not do pre-approvals.

Blue Cross' criteria is the same as Medicare's. It simply has to

be medically necessary. They don't make people jump through

hoops as some insurance companies do, but at the same time,

they are not setting us up to dump the entire bill in our laps. They

simply are trying to simplify the process, cut down on

paper-work.

If you need help finding the surgery listed in the benefits books

or the 'disclaimer' warning not to sign a financial agreement,

please contact me and I'll try to help you find both.

Who is your surgeon?

Basically, what you want to do is to get your surgeon's office to

participate in making this work smoothly.

good luck,

gobo

Lap DGB/ Dr.

July 9, 2001