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
Patient Responses to the Question Above
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.
APPROVED
by: Anonymous
Mine was denied at first also, but my doctor did what they call a "peer to peer consult" with Blue Cross Fedral and got it approved......just keep fighting and don't take no for an answer.
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.
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!
Gastric Bypass
by: BeBe
I have BCBS Federal and would like to to know a Ball Park figure for out of pocket costs for Gastric Bypass?
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!
To Heather
by: Jamie
WAY TO GO!!!!!!
What paperwork did you submit to BC/BS Federal to get it approved?
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.
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 have 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.
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. But I have an extensive family history of obesity, 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....
denied
by: Anonymous
I went through EVERYTHING on the checklist given at the first appointment. Now was told I need 2 comorbidities because my BMI was not high enough the past 2 years(both years 38 and 39 BMI, needed 40). I have high blood pressure and am on Lisinopril/HCT but was told I have to be on 2 meds and it still be uncontrolled.
Do I need to be practically dead before they will approve? What else can I do?
Denied
by: Anonymous
I was just denied, this week..... I'm so disaapointed. My BMI is 38.1 this year but 34 last. I suffer from hypertension and GERD, but they still denied me. I'm also off work due to carpal tunnel and plantar fasciitis and osteoarthritis.
Although I don't have the highest BMI, I believed my other health factors would help. In my family history is hypertension and diabetes.... My doctor wrote me a letter, to submit for more info but should I also get one from my workmen comps Doctor as well???
Help!!!!
Lap band fep bcbs
by: Rayven
I'm about to submit paperwork for lap band. I want something removable with the least amount of open surgical wound. I'm a nurse and I struggle at work because I need to be on my feet everyday. I am about BMI of 38 with the lesser comorbidities like GERD and venous stasis.
I have Fed BCBS, I'll let you guys know how it goes.
New 2017 BCBS guidelines
by: Cyndi
I summited my paperwork for the approval December 21st, 2016. Jan 3rd I was denied by Fed BCBS. As of 2017 Fed BCBS changed their qualifications. I am very unhappy with the decision. Now I have to appeal the decision.
I'm not going to give up.
Gastric Sleeve Surgery
by: Mamie
I have Standard Federal BCBS. I am 62, 5'6" and weigh 230 pounds. My BMI is 37.8. I have HTN uncontrolled with Losartan/HCT and Amlodipine, Sleep apnea with CPAP, High Cholesterol controlled with Simvastitin, and multiple areas of Osteoarthritis. I am being evaluated right now for a possible hip replacement. I do not drink or smoke.
What are my chances of being approved for the Gastric Sleeve Surgery?
Denied
by: Donna
BCBS Fed denied my gastric sleeve. (BMI 35, must be 40....was told to gain 25 more pounds!!!). And/or needed 2 comorbidities (have none but very strong family history of obesity, Diabetes, hypertension). I had gone through all the ore-op stuff before being denied (had to do all the pre-op stuff before claim could be submitted).
I went to Mexico! Best decision ever! The facility, staff and doctors were top-notched (I'm an RN and was very aware of the conditions and skills). $6800 flat. No hassling with BCBS
bcbs federal
by: lapbandfailure
I have had lapband for 3 years, BCBS federal paid for placement, it is not effective. My BMI has gone from 38 to 40. Insurance only pays for lapband removal if medical complications are present. BCBS Federal denied request for lapband to gastric bypass revision. :-(
Gastric Bypass
by: Demetra
I'm Currently awaiting approval for Gastric Bypass My Paper Work was submitted on 10/17 /18 and today is 10/28/2018 still no word. I really need this:
BMI 43.2
Hypertension (Benicar 40mg)
High Cholesterol
G.E.R.D
Hiatal Hernia
Fibromyalgia
osteoarthritis Hip
Herniated Disk Lumbar spine
Anemia
They had me submitted 2yr weight history
3 month controlled diet
Physical Eval
Upper GI
Letter of Referral form Primary care
A journal of my weight loss attempts
A nutritional consult
Attend weight loss seminar
So I remain hopeful I will be approved.