Federal BCBS changing at the first of the year!!

DivaDimples
on 12/5/10 6:48 pm - LA
Just got a call from my doctor's office, it really made me upset. I was completely done with the process of preparing for surgery, and the list of requirements. I was told by the nurse that since I'm not having my surgery until next year; starting January 1st Federal BCBS criteria for approving the surgery will be changing. So now it's like I'm starting all over again.
 
In addition they want a medical history showing that I have been overweight for more than 2 years, documentation that you have had a conversation with you doctor about weight issues, 3 months supervised diet, 3 visit with a dietitian, a visit with a psycho therapist. You get that picture.

So I was ask if I could have surgery this month to avoid all of the additional steps, but unfortunately I'm not prepared to take off this month. It kind of bummed me out but, but I rather be slow but sure. I really don't want to rush with my surgery.. Just wanted to give a heads up for those of you who have Federal BCBS.
aprile93
on 12/5/10 8:02 pm
You shoudln't need a month off! I had my surgey on a Saturday & was back at work the next monday (10 days later). But to be honest, I really could have gone back to work 4 days after surgery. I am serious, it was that easy on me. Maybe it depends on surgeon.....but I was back to normal in a flash. My boyfriend had the VSG as well, with a different doc. He took 2 weeks off originally, but only needed 1.

I would be afraid of not getting the surgery at all, over needing an entire month off to recover. But taht's just me!
 History:  Highest:259  Surgery Day:227  Current:151  Goal:145  Surgeon Goal: 160 
  Size 6 & loving it    ~ My sleeve has given me my life back~                                                   
               
jovigrl62
on 12/5/10 8:02 pm - Scroggins, TX
VSG on 11/18/10 with
 That's what my ins required for my surgery any way, well I had a 6 or 3 month option. I took the 3 and it was up before I knew it. Had sleeve on the 18th of Nov.
The 3 month diet and dietitian is the same thing I had 3 classes on nutrition and we went over my diet. My Dr's office did everything for me.Made it so easy. Thank you Dr. Davidson.
Let's get SKINNY together!                
kalex21211
on 12/5/10 8:11 pm - Ponchatoula, LA
VSG on 06/21/10 with
I say go for it! It will be the best Christmas Present you could give yourself....and Dr. Lavin is one of the best in the business.  You are in good hands!

Not sure about what your cir****tances are, but I do not think you will need a month off work.  I was back at work a week after my surgery.  I do not do any heavy lifting so I didnt have to worry about that, but that would be the only reason why I could think that I wouldnt have been able to go back so soon.  
Best of luck to you!
Karen
VSG done on June 21, 2010
 
 
marilynstraitwell
on 12/5/10 8:33 pm - Houston, TX
idk how that will b different?/ i had vsg w/fed bcbs 10/11...those were all my reqs....good luck!
        
QueenMoe
on 12/5/10 10:14 pm
That sounds like heaven to me. I have Kaiser and for me it's been a year-long process. I had to apply and get accepted. Now I have to take a series of classes on the surgery and nurtition. I did not even get into these classes until 10 months after my approval. Now I have a physical and a psychological evaluation to get through and THEN they'll schedule me for surgery.

It's a process and if you can get it this month, I'd do it. It sounds like it beats waiting around and jumping through more hoops. And if you have a job that's most sendentary, from what my weight loss surgery nurse told me, you can go back to work as early as a week later.

Good luck!
bubbacrabb
on 12/5/10 11:50 pm - Phoenix, AZ
Well I would call the insurance company yourself. My doctors office tried to get me to jump thru a lot of hoops I didnt need to with the bcbs fed program. They tried to say I needed weigh ins, and proved weight loss atempts. I called them and needed none of that. My doc said it would take months to get approved, I pushed em one day to get it submitted and within 24 hours I was scheduling a surgery date. BCBS federal is so fast. The good thing is if they deny you, just tell them you will appeal it once and give them a chance to make it right. They will then most likely say what do you mean. Then tell them the next appeal will go to OPM. They wont deny you then. The federal contract is so big they dont want to make big momma upset. Its to much money to make them mad. Good luck. If I was you i'd just get it done this month. I waited 1 month from initial consult til surgery. Best decision ive ever made. I am getting my gall bladder out this week from the same doc. The 150 lbs or so I've lost sense surgery is well worth frying my gallbladder.
       
Hollyhock
on 12/6/10 3:13 am - VA
Ugh! Do you know whether if you go ahead and submit to insurance and get prior approval in 2010 (even if the surgery is in 2011) that you can skip the extra req's? I think the prior approval gives a window of eligible dates, which might spill over to next year.

I have the same insurance, and my problem is that I'm waiting on an appeal. I can't meet the 2yr morbid obesity requirement, so if they drag it into next year I'm s****d. Would love to hear what you learn about this. Good luck!!!
tinamarie47
on 12/6/10 6:06 am - Hot Springs, SD
   Hello Diva...

I have fed BC/BS as well and just received my approval for the sleeve or the band as my DR submitted for both as South Dakota does not usually approve the sleeve-they did for me but only until 12/31/10 so after reading your letter I can see why. I have already jumped through the hoops over the past 6 months but am hoping to schedule my surgery date today for around the 20th.

My best advice is to be in prayer about your decision. I personally called BC/BS and spoke with them and they gave me all the info and told me where to find my coverage & requirements which I printed out and gave my DR so he could use their wording. Must have helped since I did get approved in 2 weeks. Best of luck to you!
                                                       
I can do all things through Christ who strengthens me.   Phil: 4:13    View more of my photos at ObesityHelp.com
DivaDimples
on 12/6/10 6:36 am - LA
Well from what I understand, even if you were approved in 2010( which I was) and you decide to have your surgery in 2011, you still have to fall under the new requirements. Its not that I don't want to have my surgery this month. but I'm the last one in at my job and my boss will not allow me to take the time off. because its very busy for us and everyone has been here many years and everyone takes vacation, and me just starting  cant take off.

My nurse showed me the memo directly from Federal BCBS and its just more loops you have to jump through to be approved. My nurse said that Federal BCBS has always been so fast and easy to work to approved the surgery and she said they are basically following suit with other insurance companies. You can go on the Federal BCBS website to see the new requirements for 2011.
marilynstraitwell
on 12/6/10 9:44 am - Houston, TX
ur very considerate of ur boss & ur job, yet u do not have to have surgery "approved" w/her/him...it is "medically necessary" surgery & they dont even have to know what the type of surgery is. keep that in mind..... good luck!!!
        
fatnomore1967
on 12/6/10 11:53 am
VSG on 10/25/10 with
another thing to think about in regards to trying to have it this year or not is your out-of-pocket expense.  come jan 1 you will be starting all over meeting your deductible.  if you have already had some medical expenses this year you may have met all or most of your yearly deductible and could possibly safe yourself money if you have it this year.  just a thought