Blue Cross Blue Shield Federal Employee Plan Denied My Gastric Sleeve Surgery

by Heather

In your section about Gastric Sleeve Surgery, it is mentioned that only two insurance companies have been known to cover it for folks in the past, one of which was the Blue Cross and Blue Shield Federal Employee Plan (FEP).

I was wondering if there is some more specific information on how this came to be known...as on many websites I was hearing stories that Federal BCBS covers the sleeve, but when I call them, they say they don't.

I sent this question directly to you (Bariatric Surgery Source), and you kindly responded to let me know that you made this determination by reviewing/considering the following resources:

1) CareFirst BCBS's web site (BCBS plan in the Mid-Atlantic) - see table on page 3
2) Obesity Help patient forum

After further pursuing the matter with Federal BCBS, they have decided not to cover the sleeve for me. At one point in our many calls, one of the benefits people said that BCBSFed was going to be reviewing its policy on whether or not to cover the sleeve in April and should have a decision in May.

Since then we cannot get anyone to confirm this or repeat it. As much as I would prefer to have the gastric sleeve procedure, I have decided to move forward with gastric bypass surgery rather than wait until it is or is not approved.

I have submitted the bypass paperwork and do believe that it will be approved by Federal Blue Cross Blue Shield even without comorbidities.

Have a great day!

Heather


Submitted 4/5/2010

Comments for Blue Cross Blue Shield Federal Employee Plan Denied My Gastric Sleeve Surgery

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Dec 08, 2012
Requirements
by: Anonymous

I have Federal BCBS of OK. My BMI is 36.1, would I even qualify for any weight loss surgeries? I (as of now) don't have any common (obesiety) related problems right now. But I have a extensive family history of obesiety, heart disease, stroke, & diabetes. My doc has even suggested going this route (and is willing to help me with any required paperwork). I want to do this as a preemptive plan. I have seen first hand what it has done. I have been on a diet for 4 months but haven't had any success. Help!! I just don't know if they would even consider me a candidate....

Sep 18, 2012
BCBS Federal Basic
by: Anonymous

Yes, BCBS Federal Basic is covering gastric sleeve now. Although they require a few things before you can even submit for approval. You ahve to meet with the surgeon first and foremost then get your records from your PCP showing the past 2 years of your medical history (they are looking for your weight history really), a psychological evaluation, be smoke free for at least 6 months and complete a 3 months medically supervised diet. I have 16 days left on my supervised diet and then the surgeons office can submit, fingers crossed.

May 21, 2012
Gastric sleeve
by: Anonymous

Has anyone had any other experience with BCBS Federal and whether they are covering the gastric sleeve? I know that regular BCBS is covering it because my sister just had the procedure done about 2 weeks ago.

Apr 17, 2012
To Heather
by: Jamie

WAY TO GO!!!!!!

What paperwork did you submit to BC/BS Federal to get it approved?


Apr 17, 2012
Cost
by: Michelle

I have to pay my surgeon 600 my deductible is 5000 and I don't have anything towards that I have to pay 5000 for the surgery.
Good Luck

Nov 04, 2011
Gastric Bypass
by: BeBe

I have BC/BS Federal and would like to to know a Ball Park figure for out of pocket costs for Gastric Bypass?

Sep 20, 2011
Requirements
by: Jamie

Can anyone tell me what the approval requirements are for the Gastric Bypass with Federal Blue Cross Blue Shield? My BMI is 38.9 and I can't find what the co-morbidities are....
What paerwork do you send them?

Thank you

Aug 17, 2011
how much does it cost
by: aimee

I have blue cross federal basic and I was hoping someone could tell me how much out of pocket cost they had.

Nov 17, 2010
APPROVED
by: Anonymous

MINE WAS DENIED AT FIRST ALSO BUT MY DOCTOR DID WHAT THEY CALL A PEER TO PEER CONSULT WITH BLUE CROSS FEDERAL AND GOT IT APPROVED......JUST KEEP FIGHTING AND DON'T TAKE NO FOR AN ANSWER.

May 07, 2010
Quick Update Since My Above Submission
by: Heather

Just wanted to let everyone know that my gastric bypass surgery was approved! I am now nine days post op.

I had two weeks of liquid diet before and as of yesterday had lost a total of 25 pounds. I am quite happy with this result as well as my tolerance for different healthy foods.

I haven't had much trouble at all... with the exception of overdoing it on walking the other day.

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