crissyboo

BCBS Fed Approval

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Today marks the start of my journey and I am a bit worried because I have insurance through my dads policy and since I will be turning 26 in 3 months my Insurance coverage will end. The requirements for my insurance company requires a 3 month supervised diet and I know I will be able to complete that, But my issue is that I am worried that I will be completing everything, But nothing will be able to happen by Oct 20th which is when my insurance will become inactive. I feel like I will be wasting my time and money for nothing. So I guess my question is do you guys think that it will be possible for me to have a date for surgery on or before Oct 20th? I spoke with the rep for BCBS FED and he stated that as long as I have a date on or before Oct 20th I will be fine.

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With less than two weeks of wiggle room, you need to work with both your doctor and your insurance company to be able to pull it off. Your doctor needs to file for the pre-authorization AS SOON AS you are eligible. It's a bummer that October 8th is on a Saturday, because you need to wait for the next business day. Work with the insurance coordinator to make sure the pre-authorization request is ready to go first thing in the morning on Monday, October 10 (or Tuesday the 11th if they observe Columbus Day). Call the Thursday morning before to confirm that all the paperwork is in order and then first thing in the morning on the first day it can be submitted. Here's a thought, is it three months or 90 days? With July and August being 31 day months, you'll hit 90 days on Thursday, October 6th and be able to get your paperwork in a few days sooner if the requirement is 90 days.

Working the other end, I recommend opening a case and being assigned a nurse case manager now to provide a consistent point of contact who knows the inner workings of your insurance company. Once the pre-authorization request goes in, begin daily follow-ups right away, always being the sweet cheerful person that your nurse case manager wants to help out. In the meantime, your surgeon will need to allow you to schedule a tentative date pending insurance approval, because you most likely won't be able to get on the surgery schedule after the approval and before your birthday. I would also suggest that you have your surgery no later than Tuesday the 18th to be sure you'll be discharged by the 20th.

I do not in any way mean to discourage you. It can be done, but it will take the doctor's office having a sense of urgency and flexibility, and it will take you developing a rapport with your insurance company and being gently persistent to move things along quickly.

Go for it, and good luck!

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Hi Chrissy, I too have BCBS FEP and I agree with everything Wendy said, it can be done. Be proactive and make sure all of your apts are met and that your advocate has received the documentation needed. If all else fails you may need to go on COBRA for one month if you can't meet the requirements.

Are you going to a Blue Distinction Center? I wish you the best of luck.

 

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Look into your dads policy to see if you would qualify for cobra coverage after your off of it. I could be way left field on this but I was so worried about loosing my job before my sleeve that I stumbled across cobra insurance option. 

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Thank you ladies for you quick and helpful responses. I went to my first dietician appointment today and we went through the whole diet before and after surgery talk. I got some good news as well. My paperwork should be submitted to the insurance company on September 1st (fingers crossed) with an expected surgery date of September 13th.

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