mstockett

Thanks everyone for your help. From what I have checked into so far with my insurance company, it looks like I am going to have a bit of a battle on my hands. So I am going to play it safe and go right to my PCP first.

Is it best to go to your family Dr. and tell them you want the lap band surgery and things start from there. Or do you cut that step out and go right to the surgeon?

Melissia

Thank you Alex. Here I am just starting out and I thought it was going to end before it even started. I will continue on as I had planned and see my Dr. and go from there as well as call BCBS back and get them to send me their criteria for the surgery. Thanks for the advice and confidence.

Melissia

I simply called my insuarance company (BCBS of Alabama) and asked if the lap band was covered under my policy and the response I got was no. I didn't ask why or anything else as my heart dropped into my stomach and I didn't know what else to say but "ok". Could she have taken the question in terms of it being an elective thing? In other words, if my Dr. submitted it them stating health reasons, might I then be approved? I have not spoken to my Dr. about this surgery yet, I figured checking with the insurance company first was the best way to start, but maybe not.

I did read on the banstersinsurance yahoo group in the database that BCBS of Alabama covered this surgery 100%.. was this just one persons experience? I am not sure what that list is really saying. I know that when I was considering gastric bypass last year I read in the Insurance coverage that 1 weight loss surgery would be covered and do not recall reading any exceptions to that. I will need to go back and dig that book out again.

Do you think I would have a better chance get apporved through my Dr? Or is no basically NO and I would have to go through an appeal? Medically I think I am a candidate for this surgery. My BMI is 51, high blood pressure, father had heart attack at 50, his father died of heart attack at 60, 2 uncles on my moms side have had heart attacks and her parents have both had numerious heart bypasses. My mom, grandmother and uncle also have diabetes.

Any insight on this would be great. Thanks

ETA: I see in my policy under exclusions that it does not cover services for obesity. BUT in the same paragraph is goes on to say, "This exclusion does not apply to surgery for morbid obesity if medically necessary and in compliance with guidelines of the Claims Administrator." So maybe I answered my own question. I am just not sure who/what the Claims Administrator is and what the guidelines are.

Hello,

I am new here and have been looking into the lap band surgery. I know this is an old thread but I would like to bring it back and see if anyone has any more info on Dr. Caylor? Where in Foley is he located?