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05-27-2008, 10:51 PM
| #1 (permalink) |
| Whipper Snapper Join Date: Oct 2007 Location: Maine
Posts: 11
Weight Statistics Soon, I hope Start Date:
Dr's appt this week for consultation Surgery Date:
5' 4" Height: 252 lb Start Weight:
237 lb Current Weight:
150 lb Goal Weight:
15 lb Weight Loss:
87 lb Lb Left to Lose:
5.95238095238 % % Lost:
Body Mass Index 43.2509765625 BMI Start:
40.6765136719 BMI Current:
25.7446289062 BMI Goal:
|  Federal Blue Cross Does anyone know the Fed. Blue Cross requirements? The doctor's secretary has an attitude and insists she talked to "someone who should know" and I have to be followed by Dr. for 6 months. I would like to have something to show the doctor that this is no so. Thanks!! 
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Yes, you can often get insurance cover for your Weight Loss Surgery. Our own Craig "Big-T" Thompson has been there and done that, and he's written an e-book about it.  |
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05-27-2008, 11:38 PM
| #2 (permalink) |
| Super Moderator  | Call your insurance company and ask what's the requirement for your particular policy. They know better than your dr's secretary.
__________________ "In every job that must be done, there is an element of fun."   Just a li'l bit 'bout myself  |
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05-28-2008, 04:28 AM
| #3 (permalink) |
| Seasoned Veteran  Join Date: Jun 2007 Location: Jacksonville, Florida
Posts: 4,513
Weight Statistics July 21, 2007 Start Date:
August 6, 2007 Surgery Date:
5' 2" Height: 287 lb Start Weight:
164 lb Current Weight:
140 lb Goal Weight:
123 lb Weight Loss:
24 lb Lb Left to Lose:
42.8571428571 % % Lost:
January 1, 2009 Goal Date:
Body Mass Index 52.4872528616 BMI Start:
29.9927159209 BMI Current:
25.6035379813 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass    | Yes, def contact the insurance carrier...just because someone that has a BCBS FED policy, doesnt mean that theirs would be the same as yours. Each policy is written for each company specifically. Good Luck to you. |
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05-28-2008, 06:08 AM
| #4 (permalink) |
| WLS Mentor  Join Date: Jan 2007 Location: Davenport, IA
Posts: 1,214
Weight Statistics 12/28/06 Start Date:
May 14, 2007 Surgery Date:
5' 5" Height: 253 lb Start Weight:
194 lb Current Weight:
150 lb Goal Weight:
59 lb Weight Loss:
44 lb Lb Left to Lose:
23.3201581028 % % Lost:
Body Mass Index 42.0968047337 BMI Start:
32.2797633136 BMI Current:
24.9585798817 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Federal Blue Cross and Blue Shield vary by the states policies. I live in IA but on the border of Illinois. My surgery center gets some patients from IL. They were very happy I lived in IA because then it would be Wellmark BCBS. IL was a little tougher to deal with. You need check out your policy. But now that I think about it, there was a requirement to be under a doctors care and a weight loss history. My doctor simply faxed my records for the last two years and of course there was always an annotation about my trying to lose weight, or be down some only to gain at the next visit. Your surgery center will need your PCP records for the past couple of years. This may be enough but you need to find out what your state requires.
__________________ Jeanne   |
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05-28-2008, 06:25 AM
| #5 (permalink) |
| WLS Master Guru  Join Date: Apr 2007 Location: Central Virginia
Posts: 527
Weight Statistics 4/30/2007 Start Date:
9/5/07 Surgery Date:
5' 4" Height: 233 lb Start Weight:
144 lb Current Weight:
140 lb Goal Weight:
89 lb Weight Loss:
4 lb Lb Left to Lose:
38.1974248927 % % Lost:
Nov 2008 Goal Date:
Body Mass Index 39.9899902344 BMI Start:
24.71484375 BMI Current:
24.0283203125 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | The policy here in Virginia was either a BMI of 40 or greater, or BMI of 35 with 2 co0morbidities. Getting them to tell you what qualifies as a comorbidity was next to impossible though. I believe there is a government representative that will work with you to find out what it is you need to qualify. Your BMI is high enough so they ought to cover it. Just keep bugging them. |
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05-28-2008, 06:40 AM
| #6 (permalink) | |
| Super Moderator | Quote:
At any rate, as I wrote before, call your insurance carrier yourself, and inquire. That way, you will know what you need to do, and what documents you need to collect as well for sure, instead of relying on second hand information and finding out that you are missing stuff that you thought you didn't need.
__________________ "In every job that must be done, there is an element of fun." Just a li'l bit 'bout myself | |
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05-28-2008, 08:02 AM
| #7 (permalink) |
| Cub Reporter  Join Date: Apr 2008 Location: Topeka, KS
Posts: 50
Weight Statistics 4/12/08 Start Date:
Postponed due to current pregnancy! Surgery Date:
5' 9" Height: 300 lb Start Weight:
295 lb Current Weight:
180 lb Goal Weight:
5 lb Weight Loss:
115 lb Lb Left to Lose:
1.66666666667 % % Lost:
Body Mass Index 44.2974165091 BMI Start:
43.559126234 BMI Current:
26.5784499055 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | I have federal BCBS --- I have the basic policy -- the policy is the same no matter what state you are in as it is a national policy....I have a friend who works in the call center here in town. Basically the requirements are that you have had to try numerous things to lose weight - not sure if that is the 6 month thing or not, but i haven't been followed by a doctor for 6 months though I have done weight watchers more than once for that long - your BMI has to be at least 40 unless you have a lot of comorbidities...I haven't gotten my approval yet - it is pending, but it is a moot point since I turned up pregnant last week. The other thing I would do is call them --- my surgeons office said that Fed BCBS wouldn't pay for the initial consult or the psych eval...which wasn't true as I called them and they approved the psych eval (under the Basic plan you have to have pre approval for mental health - under standard option you don't) and they will pay for the consult, too. (this part just changed in 2008, I am told. Hope that helps --- call the carrier and write down the name of who you talk to....ask her tons of questions...that's what they are there for! ~Kim
__________________  Me and my girls, Saige & Mallory   |
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05-28-2008, 09:54 AM
| #8 (permalink) |
| Seasoned Veteran  Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 3,609
Blog Entries: 1 Weight Statistics September 19th 2007 Start Date:
September 19th 2007 Surgery Date:
5' 10" Height: 363 lb Start Weight:
211 lb Current Weight:
165 lb Goal Weight:
152 lb Weight Loss:
46 lb Lb Left to Lose:
41.8732782369 % % Lost:
12/31/09 Goal Date:
Body Mass Index 52.0793877551 BMI Start:
30.2720408163 BMI Current:
23.6724489796 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | I used to have to precert all surgerys etc at the practice I worked for. You acutally have probally the best insurance policy I ever ran accross. You do however need to call them and ask if they cover WLS and what there guidelines are. Write it down along with the persons name you spoke with. |
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05-28-2008, 10:06 AM
| #9 (permalink) |
| Cub Reporter Join Date: Apr 2008 Location: Topeka, KS
Posts: 50
Weight Statistics 4/12/08 Start Date:
Postponed due to current pregnancy! Surgery Date:
5' 9" Height: 300 lb Start Weight:
295 lb Current Weight:
180 lb Goal Weight:
5 lb Weight Loss:
115 lb Lb Left to Lose:
1.66666666667 % % Lost:
Body Mass Index 44.2974165091 BMI Start:
43.559126234 BMI Current:
26.5784499055 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | I agree ---- federal BCBS is one of the best out there. I have had a LOT of medical things done while we have been on it and the coverage is fantabulous.  No charge for "well baby" visits, free labwork....and ALL my prenatal stuff is covered! (a HUGE plus since I am high risk and have lotsa sonograms, blood work, etc...) When I priced out what the surgery would cost me under the basic plan it was just office visit copays, the psych copay which is $20, and then hospital fees ---- which under the basic plan is $100 a day...meaning probably 2-3 days after surgery, from what my doc told me. So it is a bargain as I have heard people having to pay hundreds even with approval from their insurance. Being a federal employee definately has its perks!Good luck! Kim
__________________ Me and my girls, Saige & Mallory |
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05-28-2008, 11:24 AM
| #10 (permalink) |
| Seasoned Veteran  Join Date: Mar 2007 Location: Texas
Posts: 1,631
Weight Statistics 3-16-2007 Start Date:
July 23, 2007 Surgery Date:
5' 7" Height: 284 lb Start Weight:
177 lb Current Weight:
160 lb Goal Weight:
107 lb Weight Loss:
17 lb Lb Left to Lose:
37.676056338 % % Lost:
7-23-08 Goal Date:
Body Mass Index 44.4758298062 BMI Start:
27.7190911116 BMI Current:
25.0568055246 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | I have the Federal BCBS and I had to do the 6 months.
__________________  I am only as strong as the caffine I drink, the hairspray I use, and the girl friends I have.  |
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