Re: Help - Anyone with BCBS Federal Standard Plan/SIRI

[Guest guest]

GOBO'

Thanks for your response. Whew, what a relief. My husband is very leery

about the RNY because of the staples -- he feels the BPDDS is much better,

safer, and more natural. So, do I. Also, the thought of heart palpitations

from dumping scares the heck out of me. I think I'd feel like I was having

a heart attack -- boy, talk about stress. I'm absolutely thrilled to find

out it is being paid for by BCBS Fed. plan for more than just one person.

I live in NC, just moved here in Jan. from S. Florida so I'm lucky that Dr.

is close by in Winston-Salem.

Now, I feel like a huge weight is lifted. I'm going to copy this message so

I can take it to my Drs. appointment.

thanks again,

Siri

Re: Help - Anyone with BCBS Federal Standard

Plan/SIRI

> Hi Siri;

> I had my BPD/DS on July 9, 2001 and my Fed Blue Cross paid everything!

> In fact, the bill was paid within 6 weeks.

> I happen to live in Washington State and had my surgery in Oregon.

>

> By the way, it's possible that the reason you can't find anyone who's

> been

> approved is because they do NOT pre-approve anymore. I do hear of

> exceptions but that's all it would be if someone happens to get

> pre-approved.

> Fed. Blue Cross has followed the lead of Medicare and stopped doing

> PRE-approvals all together.

>

> The way they work it now is that you go ahead and get your surgery

> FIRST.

> Then, IF you were qualified for it, they will promptly pay the bill.

> If you were

> not qualified, they deny it.

>

> This may sound scary but it actually is very simple and straight

> forward. In my

> case, I was 185 pounds overweight. The qualification is the same as

> Medicare: that the patient be at least 100 pounds over weight. So, I

> went

> ahead with no worry about it. If you have your Fed BC/BS Service

> Benefit

> Plan booklet, look on page 41 (Surgical procedures). It says right

> there that

> the requirement is 100 pounds overweight. Nothing else is listed as a

> requirement. I happen to have HIGH option but the requirement is

> the same; the only difference is that STANDARD pays 90% while

> the HIGH option pays 95%.

>

> This is for 'gastric bypass surgery'. My surgeon coded all her

> surgeries as

> 'Distal Gastric Bypass' in order to comply with insurance companies'

> standards. However, my experience with Federal Blue (in my case and

> others

> as well) is that they do NOT have a problem paying for this AS LONG

> AS you

> are a minimum of 100 pounds overweight.

>

> I hope I've helped shed some light on this for you. Right now you

> should be

> focusing on yourself and your surgery; not on insurance. It's awful

> that

> insurance companies make folks jump through hoops so much. I wish

> there

> was something we could do to prevent it.

>

> By the way, one last statement. Since you probably won't have surgery

> until

> next year, I would inspect the Fed. Blue benefits for next year very

> carefully.

> Open-enrollment period is almost here and you might want to make sure

> that

> Fed. Blue is not changing their WLS coverage.

>

> Good luck!

>

> gobo

>

>

> > I've posted on several Yahoo chat groups and haven't received any

> messages.

> > I have my first consult with the surgeon on 10-31. I know for a

> fact that

> > RNY Proximal can be approved with no problems but I'm trying to

> find out if

> > anyone with BCBS Fed. Standard Plan has been approved for BPD/DS.

> I've

> only

> > heard from one gentlemen who lives in my State (NC) that was

> approved.

> My

> > BMI is 47, and his was much higher at around 60. I there is more

> than one,

> > I believe it would be worth it to appeal, ect. If not, well....

> >

> > I had a heart attack 2 1/2 yrs. ago and have a coronay stent. I'm

> not crazy

> > about dumping which may cause heart palpitations, plus I don't like

> the

> idea

> > of having staples inside forever and ever.

> >

> > If you have another federal insurance plan that has approved BPD/WS

> please

> > let me know. I would consider changing during open season to be

> able to

> get

> > the the BPD/DS surgery.

> >

> > I would really appreciate your help.

> >

> > Siri

> > >

> > >

> > > ----------------------------------------------

> ------------------------

> > >

[Guest guest]

Thanks. Now that I'm getting some responses, I feel confident that I can

get mine paid without a hitch, too. Once they pay for one patient, they

can't deny others in the fed. plan. My BMI is about 47, but as someone

mentioned earlier, the criteria is 100 pounds overweight -- I definitely

qualify for that.

Relief, relief.

Re: Re: Help - Anyone with BCBS Federal Standard

Plan/SIRI

> Siri,

> I had my surgery in June and fed BCBS paid for my DS. I had standard

option.

> 90%

>

>

>

[Guest guest]

Hi Siri;

I had my BPD/DS on July 9, 2001 and my Fed Blue Cross paid everything!

In fact, the bill was paid within 6 weeks.

I happen to live in Washington State and had my surgery in Oregon.

By the way, it's possible that the reason you can't find anyone who's

been

approved is because they do NOT pre-approve anymore. I do hear of

exceptions but that's all it would be if someone happens to get

pre-approved.

Fed. Blue Cross has followed the lead of Medicare and stopped doing

PRE-approvals all together.

The way they work it now is that you go ahead and get your surgery

FIRST.

Then, IF you were qualified for it, they will promptly pay the bill.

If you were

not qualified, they deny it.

This may sound scary but it actually is very simple and straight

forward. In my

case, I was 185 pounds overweight. The qualification is the same as

Medicare: that the patient be at least 100 pounds over weight. So, I

went

ahead with no worry about it. If you have your Fed BC/BS Service

Benefit

Plan booklet, look on page 41 (Surgical procedures). It says right

there that

the requirement is 100 pounds overweight. Nothing else is listed as a

requirement. I happen to have HIGH option but the requirement is

the same; the only difference is that STANDARD pays 90% while

the HIGH option pays 95%.

This is for 'gastric bypass surgery'. My surgeon coded all her

surgeries as

'Distal Gastric Bypass' in order to comply with insurance companies'

standards. However, my experience with Federal Blue (in my case and

others

as well) is that they do NOT have a problem paying for this AS LONG

AS you

are a minimum of 100 pounds overweight.

I hope I've helped shed some light on this for you. Right now you

should be

focusing on yourself and your surgery; not on insurance. It's awful

that

insurance companies make folks jump through hoops so much. I wish

there

was something we could do to prevent it.

By the way, one last statement. Since you probably won't have surgery

until

next year, I would inspect the Fed. Blue benefits for next year very

carefully.

Open-enrollment period is almost here and you might want to make sure

that

Fed. Blue is not changing their WLS coverage.

Good luck!

gobo

> I've posted on several Yahoo chat groups and haven't received any

messages.

> I have my first consult with the surgeon on 10-31. I know for a

fact that

> RNY Proximal can be approved with no problems but I'm trying to

find out if

> anyone with BCBS Fed. Standard Plan has been approved for BPD/DS.

I've

only

> heard from one gentlemen who lives in my State (NC) that was

approved.

My

> BMI is 47, and his was much higher at around 60. I there is more

than one,

> I believe it would be worth it to appeal, ect. If not, well....

>

> I had a heart attack 2 1/2 yrs. ago and have a coronay stent. I'm

not crazy

> about dumping which may cause heart palpitations, plus I don't like

the

idea

> of having staples inside forever and ever.

>

> If you have another federal insurance plan that has approved BPD/WS

please

> let me know. I would consider changing during open season to be

able to

get

> the the BPD/DS surgery.

>

> I would really appreciate your help.

>

> Siri

> >

> >

> > ----------------------------------------------

------------------------

> >

[Guest guest]

Siri,

I had my surgery in June and fed BCBS paid for my DS. I had standard option.

90%