Blue cross blue shield federal basic (live in tx)

I'm just wondering... has anyone had to wait to complete a 6 month diet plan or whatever? With FEDERAL Blue Cross Blue Shield Basic or Standard?

From the first time you saw the doctor... how long did it take you to have the surgery and what was the process?

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Hi there - this was a new rule when I was in the approval process for BC/BS and my family practitioner allowed me to write up my own journal based on my previous visits and include my weight. So although I officially did not do another 6 months of diet and exercise logs - my previous office visits for various reasons were counted. I typed it up - doc signed it and it worked. Good luck!

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Dr. Alexander Abkin
Florham Park, NJ
banded 2/5/2008

Thread Starter

are you a federal employee?

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I have BC/BS Federal Iowa. I was approved very quickly. My BMI was over 40 with no co-morbidites. If you have co-morbidities the BMI can be less. BC/BS Federal is VERY good insurance for this surgery.

I have always obtained copies of my doctor visits so I just wrote a note explaining my weight problems through the years and included doctor's notes showing my weight and I was approved within a couple of weeks after submitting everything. I pray you do as well.

One of the ladies at the insurance company said, "You are so lucky to have this insurance. They take very good care of their people."

Thread Starter

I don't have any copies of my doctors visits..... i'm sure medical records will show my weight over the years?

I hope it goes as easy as most people......

I do have sleep apnea and it is diagnosed and I have been on a CPAP machine for almost 5 years now. And, my BMI is over 40..... so, you would think I would have no problems.

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I am not a federal employee......and I agree - BC/BS is one of the best insurances to have for this procedure. Just got my hospital bill - I owe less than $20 - day procedure - no overnight stay.

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Dr. Alexander Abkin
Florham Park, NJ
banded 2/5/2008

I have the exact same insurance as you (BC/BS federal Basic) and I also live in Texas. I was told that our insurance is a "quick approval" if you have a BMI over 40 or have comobities. I was just at 40 BMI and my doctor's office submitted my paperwork and within 10 days I was approved. I had my surgery almost two weeks later. My doctor required me to do a iquid type diet the 12 days before my surgery to shrink my liver but that was it. Good luck!

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8/13/08 - Seminar
9/14/08 - Submitted to BCBS
9/30/08 - BCBS approved (started preop diet)
10/13/08 - Banded! (lost 14 lbs on preop diet)

Thread Starter

Man, i'm so excited! You just paid a 100 dollar co-pay for the doc and 100 dollar for the hospital?

longhorn mom.. which doc and clinic did you go through? Did you have any problems with them and how did you like them?

I just hope I don't run into a road block. I have been a federal employee in the past for a year starting nov 07..... paid blue cross blue shield out of my check every two weeks but i never even used the insurance.

I left the job for health reasons.

A year later I am about to start back....

I just hope me just working part-time doesn't get in the way of what it covers. I wouldn't think that it would?

As soon as the insurance kicks in i'm going to the doctor.....

do you think me working part-time on and off... will get in the way? Or, with me just starting the coverage in Nov and going to the doc to have the surgery in Nov?

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I really don't think it will matter - once you are approved for insurance, you have the coverage. Just don't have the doc's office send in your request until after your coverage date starts. Good luck to you!

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8/13/08 - Seminar
9/14/08 - Submitted to BCBS
9/30/08 - BCBS approved (started preop diet)
10/13/08 - Banded! (lost 14 lbs on preop diet)

Thread Starter

Which doctor did you use? What clinic? Did your primary do all the paperwork for you?

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Creed,

I just got approved yesterday with BCBS of Texas (TRS). I had to do the 6 month supervised diet, I finished my last appointment last Monday the 20th. The office submitted it on the 20th and I was approved yesterday the 27th. I am scheduled for my band on November 17th. Not a particular painful process it just took the 6 months. I am 38 years old and 275 lb. and have a BMI of 41 and have sleep apnea. Hope that helps.

Thread Starter

ugh.. I get different stories with different dr offices.

I had one tell me that although they don't require a "DR" supervised medical weight loss you have to show proof, (Jenny Craig, etc.) for at least six months. She said I could not turn in the medical records showing my history of me being over-weight and writing a statement on my weight loss attempts over the years. I again asked her are u sure... this is not regular blue cross..this is federal. she said she called blue cross and even looked in the book...and it says it is required.

Then, I call another office... no diet history is required with federal insurance..... she said they will schedule an appointment... on that day I have my psych eval and meet with nutritionist. She said they request the medical records and see how long I have been over-weight.
She said they get the paperwork together..and submit it to the insurance and it usually takes about 3 days to get an approval.

I asked her...so, I don't have to do a diet for 6 months? she said no it is not required for federal blue cross blue shield insurance.

she said realistically december is so busy for them that the surgery would probably be sometime in january if all went well.

she basically said i'm a 'slam dunk' patient with my bmi and my sleep apnea.

I hate getting different stories from different offices... the last one is the only one out of 3 offices that said it is not required. I think they are getting mixed up with regular blue cross and federal blue cross or something?

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The benefit book for Federal BCBS does not state that a 6 month supervised diet is required; so if your BMI meets criteria and especially with other issues you should be approved quickly.

Thread Starter

that is what I don't understand... where are they getting their information from? oh well...i'm sure everything will go well in a few weeks. I'll be seeing the doc prolly November 14th along with my psych eval and seeing a nutritionist. *crossing fingers*

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Thread Starter

Can you please point me to the direction where it says this online? I would like to have this in case this becomes an issue.

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