anyone else have BCBS for Fed employees in Ohio?

DianaG · 10-23-2009, 01:56 PM

Just checked to see what my BMI was when I started this process..it was 43.

Bridget, where in NE are you located?. I have a son and daughter-in-law who live in the Omaha area.

DianaG · 10-23-2009, 02:10 PM

Courtney, I just now noticed that you mentioned that your surgeon was in the basic network. Good Deal!

One thing I don't understand is that if your BMI is 40.3, how come they are still saying that you need the supervised diet. The brochure I quoted the info from doesn't make any distinction about the requirements for Basic of Standard. It only makes a distinction about the payment of benefits and how much is owed.

It wouldn't hurt to call the phone# on the back of your ins. card and ask them why if your BMI is 40 or over, you were told that you would have to do this but that a friend (me

) with a BMI of over 40 had the surgery in July and was not required to have a supervised diet. I do have several co-morbidities, but was told that those didn't matter since I was over 40 BMI. After all, the requirements are supposed to be the same in every state!! Sometimes I think that the answers to questions vary between personnel. Whoever answers, the phone one time may not tell you what the other person told you on a previous call!

O.K. I am done ranting now.

BetterMeCourtney · 10-23-2009, 10:11 PM

Diana, I agree. I will try and call tomorrow (not sure how much luck I'll have since it will be the weekend), and hopefully I'll get someone other than who I spoke to today.

I also called the True Results center today but only got an answering machine. The sheet they gave me at my first appointment listed the requirements I would need to fulfill before my surgery, but I'm wondering if it was based upon my estimated BMI I gave them when making the appointment. I thought I would be at 38.

I'll keep you updated on what I find out. I'm sure they shouldn't be making me do the 3 months... The more I read the benefits, the more I believe this is true. Someone.. somewhere along the way is confused, lol and they're trying to take me with them.

tiffanye · 10-24-2009, 12:01 AM

I have the basic

I had a BMI over 40 i think it was 43. I didn't have to do any special diet before to be approved and after my psych eval i was approved in like three days. I had to pay a 100 dollar copay for the surgeon. there was a co-surgeon but she didn't count. So I just had to pay the 100. Although i did stay over night because my hospital was too far way my doc wanted me to stay over night. if i hadn't been an inpaitent i would have had to pay for the supplies in the operating room including the band. So since it was inpaitent i only paid the copay. i don't remember where I saw this in the book. its tricky to find and i had to show the insurace people at my hospital because they had never came across it. i think it was like in with the general surgery info.

BetterMeCourtney · 10-26-2009, 11:37 AM

aaaargh! So I talked to the true results advocate this morning, and she said that they always do the three months appointments because she's never seen a fep plan approve without it. She would not listen to anything I said. I'm very discouraged and a little bit pissed that she just disregarded everything I said.

DianaG · 10-27-2009, 11:15 AM

Hey Tiffany, it looks like this is a case where basic pays better than standard, as long as you go to a preferred facility! That's great!

Courtney, I can't believe what an ignorant person you talked to on the phone!! Obviously you will never be able to explain anything to her!

You can talk to her until you are blue in the face and all she will tell you is the same thing over and over. She has dug in her heels and won't move. It may well be that she is sticking to the clinic's policy of having a 3 mo diet, but it is certainly not the policy of BCBS FEP.

I suggest that you call and ask to speak to her supervisor. You may even have better luck if you make an appointment to go see her supervisor!! There has to be someone there who has dealt with our insurance program.

If you do go to see the supervisor, you could give her/him the phone# off the back of your ins. card and have them call while you are sitting there. The Ins. co. representative should be able to explain what the requirements are. You could also tell them about all of us on this site who have had the surgery and that it HAS paid for us.

Just some thoughts. Hope you can get some positive answers! I'll keep my fingers crossed!

abbylamb · 10-31-2009, 08:39 AM

Well, I went in for my consultation yesterday (different office, one that won't require 3 months of dietician visits)---according to their office I'm a perfect candidate and they said they'll be putting in the request to the insurance the beginning of next week, which means I could conceiveably have a surgery date before the end of the year!!! Please keep your fingers crossed for me that they approve right away!

DianaG · 11-01-2009, 05:14 PM

Abby that is great news. I will keep my fingers crossed for you!! Wouldnt that be a great Christmas/New Year's gift for you...

Let us know what happens.

abbylamb · 11-03-2009, 06:42 AM

Hey guys---the doc's office is submitting to the insurance company today.

Keep those fingers crossed for me that I get a yes and quickly! I don't know how long I can stand the suspense! I don't do 'patient' well!

DianaG · 11-05-2009, 11:09 PM

Fingers crossed until we hear that you got approved!!!

abbylamb · 11-06-2009, 01:35 AM

Thanks! This wait is KILLING me!!!

I think I'm going to call and check on the status of it tomorrow, because I just can't stand waiting anymore!!

abbylamb · 11-06-2009, 07:29 PM

I'M APPROVED!!!

I'm gonna be a December bandster! I can't wait!!! Thanks to everyone for keeping those fingers crossed---it worked!

DianaG · 11-06-2009, 10:50 PM

I am so glad that you hung in there and did the work to make it happen!!!! Now you are on your way!!!

CONGRATS!!!!WAY TO GO!

abbylamb · 11-07-2009, 08:44 AM

Thank you!!!! I don't think I could have done it without everyone's support and well wishes. Who would have thought I'd actually be looking forward to an upper GI???

But I am because that's one of the few things standing in front of me and my surgery! I can't wait!!!

abbylamb · 11-10-2009, 01:39 PM

Just an update---surgery is officially scheduled for December 21!