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Old 09-11-2011, 12:35 AM   #1 (permalink)
Whipper Snapper
 
LoserMama's Avatar
 
Join Date: Sep 2011
Location: Boise, ID
Posts: 19

Weight Statistics

12/21/11
Surgery Date:
5' 7"
Height:
278 lb
Start Weight:
251 lb
Current Weight:
150 lb
Goal Weight:
27 lb
Weight Loss:
101 lb
Lb Left to Lose:
9.71223021583 %
% Lost:

Body Mass Index
43.536199599
BMI Start:
39.3078636667
BMI Current:
23.4907551793
BMI Goal:

Weight Loss Method
Sleeve Gastrectomy
Default Fepblue federal blue cross basic option 2011?

Anyone been approved for surgery in 2011 through federal blue cross blue shield standard option?

What kind of hoops did you have to jump through and how long did it ultimately take? It doesn't have a lot of detail in the plan documentation, unless I missed something.

Thanks in advance if anyone has been there/done that.
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Julie

Boise, ID
VSG scheduled for 12/21/11
Highest weight (non pregnant): 278
Height: 5'7"
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Alt Weight Loss Surgery Insurance
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.

   
Old 09-11-2011, 09:54 AM   #2 (permalink)
Seasoned Veteran
 
judst's Avatar
 
Join Date: Jan 2011
Location: Orting, Wa.
Posts: 2,594
Blog Entries: 1

Weight Statistics

February 2011
Start Date:
August 16th 2011
Surgery Date:
5' 10"
Height:
283 lb
Start Weight:
157 lb
Current Weight:
165 lb
Goal Weight:
126 lb
Weight Loss:
-8 lb
Lb Left to Lose:
44.5229681979 %
% Lost:
June 2012
Goal Date:

Body Mass Index
40.6018367347
BMI Start:
22.5246938776
BMI Current:
23.6724489796
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

Julie, I don't have the same insurance but I wanted to tell you that you can request them to send you a copy of the specific policy covering bariatric surgery. I called my insurance in the beginning and was given a website that had the full policy in it. Sometimes you need to find the right person to talk to though to get an informative response.
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Old 09-11-2011, 10:09 AM   #3 (permalink)
Whipper Snapper
 
LoserMama's Avatar
 
Join Date: Sep 2011
Location: Boise, ID
Posts: 19

Weight Statistics

12/21/11
Surgery Date:
5' 7"
Height:
278 lb
Start Weight:
251 lb
Current Weight:
150 lb
Goal Weight:
27 lb
Weight Loss:
101 lb
Lb Left to Lose:
9.71223021583 %
% Lost:

Body Mass Index
43.536199599
BMI Start:
39.3078636667
BMI Current:
23.4907551793
BMI Goal:

Weight Loss Method
Sleeve Gastrectomy
Default

Thanks Judi, great suggestion! I will do that.
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Julie

Boise, ID
VSG scheduled for 12/21/11
Highest weight (non pregnant): 278
Height: 5'7"
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Old 09-11-2011, 10:09 PM   #4 (permalink)
Big Loser
 
Join Date: May 2011
Posts: 129

Weight Statistics

26 May2011
Start Date:
9 June 2011
Surgery Date:
5' 9"
Height:
268 lb
Start Weight:
147 lb
Current Weight:
142 lb
Goal Weight:
121 lb
Weight Loss:
5 lb
Lb Left to Lose:
45.1492537313 %
% Lost:
Mid 2012
Goal Date:

Body Mass Index
39.5723587482
BMI Start:
21.7057340895
BMI Current:
20.9674438143
BMI Goal:

Weight Loss Method
Roux en Y Gastric Bypass
Default

I have it and the only "hoop" was a 6 month history of not smoking.

All the other hoops were required by my surgeon. :-) All the psych and nutrition appointments, etc..

It took me well over a year but that was due to my crazy busy schedule. Once I put my foot down and started taking care of me it was a few months. Take out my schedule issues and it probably would have only taken about 6 months.

Call your BCBS and ask for the specific requirements. I found a voice on the phone to be much more explanatory than the minimal words in print.
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Old 09-11-2011, 11:43 PM   #5 (permalink)
Whipper Snapper
 
LoserMama's Avatar
 
Join Date: Sep 2011
Location: Boise, ID
Posts: 19

Weight Statistics

12/21/11
Surgery Date:
5' 7"
Height:
278 lb
Start Weight:
251 lb
Current Weight:
150 lb
Goal Weight:
27 lb
Weight Loss:
101 lb
Lb Left to Lose:
9.71223021583 %
% Lost:

Body Mass Index
43.536199599
BMI Start:
39.3078636667
BMI Current:
23.4907551793
BMI Goal:

Weight Loss Method
Sleeve Gastrectomy
Default

Firefox, thanks that is so helpful to know. I finally found a more detailed explanation -- and here is what it says, in case this helps anyone else:

"Gastric restrictive procedures, gastric malabsorptive procedures and combination restrictive and malabsorptive procedures to treat morbid obesity -- a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with co-morbidities who has failed conservative treatment; eligible members must be 18 or over.

.....blah blah...prior approval....

...subject to the following pre-surgical requirements:

Diagnosis of morbid obesity for a period of 2 years prior to surgery
Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs...)

Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise.

Evidence that attempts at weight loss in teh 1 year period prior to surgery have been ineffective

Psychological assessment of the member's ability to understand and adhere to the pre- and post-operative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse

Patient has not smoked in the six months prior to surgery

Patient has not been treated for substance abuse for 1 year prior to surgery

My share: $150 per surgeon
$0 for anesthesia (if using a preferred provider)
$150 per day for hospital stay
$0 for diagnostic labs, ekgs as requested by physician
$25 per visit for psych (preferred provider)

So sounds pretty decent for coverage, I would say, I think I'm lucky if this all works out.


hope this info helps others, the thing i'm most curious about is the 3 month medically supervised deal...the paper work from the doc says they will not schedule surgery until all requirements are met and approval from insurance and they are scheduling a ways out, so its possible I may not make a 2011 date boo. if I have to complete 3 months before they submit for authorization, that puts me at mid december, and if they are scheduling 2-3 months out for surgery....thats into march, which is NOT the timing I had hoped for at all. I wonder if there is any flexibility if its only the doctors requirements....hmmmmm...
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Julie

Boise, ID
VSG scheduled for 12/21/11
Highest weight (non pregnant): 278
Height: 5'7"
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Old 11-30-2011, 02:18 PM   #6 (permalink)
Newbie
 
Join Date: Jul 2011
Location: Tampa Bay
Posts: 9

Weight Statistics

7/11/2011
Start Date:
4' 10"
Height:
207 lb
Start Weight:
207 lb
Current Weight:
125 lb
Goal Weight:
82 lb
Lb Left to Lose:
12/2012
Goal Date:

Body Mass Index
43.2583234245
BMI Start:
43.2583234245
BMI Current:
26.122175981
BMI Goal:

Weight Loss Method
Adjustable Gastric Band
Question

Quote:
Originally Posted by LoserMama View Post
Anyone been approved for surgery in 2011 through federal blue cross blue shield standard option?

What kind of hoops did you have to jump through and how long did it ultimately take? It doesn't have a lot of detail in the plan documentation, unless I missed something.

Thanks in advance if anyone has been there/done that.
DEC 1st and I am waiting for FEPBLU basic to hurry up and approve, did you get done? how long did they take after package was submitted?
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Old 11-30-2011, 05:48 PM   #7 (permalink)
Whipper Snapper
 
LoserMama's Avatar
 
Join Date: Sep 2011
Location: Boise, ID
Posts: 19

Weight Statistics

12/21/11
Surgery Date:
5' 7"
Height:
278 lb
Start Weight:
251 lb
Current Weight:
150 lb
Goal Weight:
27 lb
Weight Loss:
101 lb
Lb Left to Lose:
9.71223021583 %
% Lost:

Body Mass Index
43.536199599
BMI Start:
39.3078636667
BMI Current:
23.4907551793
BMI Goal:

Weight Loss Method
Sleeve Gastrectomy
Default

I did get it done, Grider, My package was submitted on November 10 and I was approved November 14th, it was very quick! Surgery scheduled for 12/21! Woohoo!
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Julie

Boise, ID
VSG scheduled for 12/21/11
Highest weight (non pregnant): 278
Height: 5'7"
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Old 11-30-2011, 06:10 PM   #8 (permalink)
Newbie
 
Join Date: Jul 2011
Location: Tampa Bay
Posts: 9

Weight Statistics

7/11/2011
Start Date:
4' 10"
Height:
207 lb
Start Weight:
207 lb
Current Weight:
125 lb
Goal Weight:
82 lb
Lb Left to Lose:
12/2012
Goal Date:

Body Mass Index
43.2583234245
BMI Start:
43.2583234245
BMI Current:
26.122175981
BMI Goal:

Weight Loss Method
Adjustable Gastric Band
Default wow

I was told today to call next week Thursday... (sigh) be nice if they did it sooner. I really want to get done this yr,,, for many reasons. My fepblue is in Jacksonville Fl. I am glad you got approved! I was hoping NOT to get into the holiday season, well nothing else I can do, but me, I'll call again this fri afternoon.
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Old 12-11-2011, 08:21 PM   #9 (permalink)
Newbie
 
Join Date: Jul 2011
Location: Tampa Bay
Posts: 9

Weight Statistics

7/11/2011
Start Date:
4' 10"
Height:
207 lb
Start Weight:
207 lb
Current Weight:
125 lb
Goal Weight:
82 lb
Lb Left to Lose:
12/2012
Goal Date:

Body Mass Index
43.2583234245
BMI Start:
43.2583234245
BMI Current:
26.122175981
BMI Goal:

Weight Loss Method
Adjustable Gastric Band
Default

I am approved and surgery Dec 22.. it actually only took 4 days and that was thanksgiving. I am hoping costs will be co-pays,,, it's Christmas I can wish!
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