Lap_dancer

Your insurance carrier may request the name of the surgery and the CPT/ICD-9 codes. Insurance companies use the following codes to identify the type of procedure or surgery: Lap Gastric Banding: 43770 Lap Gastric Bypass: 43644 Diagnosis Code (ICD-9) for Morbid Obesity: 278.01

See the web address? The first part of it is BCBSNC.com that is Blue Cross and Blue Shield of North Caroline. The remainder is services and their obesity memo. The medical codes are what are standard use in the field of medicine for a diagnosis and a code for medical purposes to process the paper work. It's on the web. No big surprise. Just go to BCBSNC's website and log in with your member number or as a guest. Your searches should be one word "gastric" "bariatric" or "obesity".

You could call your local AAA just to be sure but I believe for a day trip like that you only need your ID which you do have. I posted back on your other thread about your ovary and cyst. I forgot to add that I was in the emergency room three times with pain and they never spotted the cyst. It was hidden behind my ovary too far for ultrasound to pick up. Exam didn't pick up anything but the tenderness on that side of my body. Ultrasound picked up the darkness on the screen (blood pooling) when my cyst finally ruptured. I am thankful that neither one of us died. Good luck on your fill. Post back on how it goes. I may be going to Dr. Ortiz.

<TABLE class=tborder cellSpacing=1 cellPadding=6 width="100%" align=center border=0><TBODY><TR title="Post 371594" vAlign=top><TD class=alt1 align=middle width=125>BrwnEydGrl82</TD><TD class=alt2>I have been on a medical leave from my job (starting last thurs) the cyst was larger than larger than a grapefruit on my and my ovary needed to be removed (which my doctor never warned me of the possibility of potentially losing an ovary nor did she pick up the cyst this past year- in which I have had 5 dr visits) But that is besides the point. Everthing worked out with taking time off and Im feeling well.</TD></TR></TBODY></TABLE> Oh my goodness this sounds like me in 1987. Exactly. My cyst was hidden behind my left ovary because it had grown and twisted itself around my tube. Painful. I lost my ovary and it's just one of those things that once they get in there they don't really know what they are dealing with. My ovary was toxic to my body at the point they recovered and removed it. I am so glad you found the source of that pain, and I'm guessing you have had it on and off for years, no rhyme nor reason just came and went and occasional pain during sex. Get well soon.

This is perfect. I believe that everything happens for a reason as well. I now believe that I was not meant to go to the surgeon I initially consulted with. He has done gastric bypass, is very pro GB, and has not done many Lap Bands. I think my wait has been to find the others who have done the procedure. I have.

Judy, I can't begin to say I know how you feel because I don't. I can only share that abyss of disappointment from being rejected three times. I can only tell you that I have it in my mind that I will get this done. Come hell or high Water I am going to have this done. I simply will not stop until I have this done. A friend told me to check for university departments doing research looking for candidates for gastric surgery. That's one of the things I am looking into, meanwhile, I am going to my insurance committee for my employer and educating them. The policy they bought has an exclusion, so many exclusions that it reads like a "fat people need not apply" application. It is very frustrating and hurtful to feel like there isn't an answer. There is one, you keep going. Don't quit. **I think of years ago when obese people had no other options. Then along came scientists and doctors who didn't quit and they came up with a remedy, another option. Over time it has progressed into one of the successful options for us. Unfotunately, like the internet, it's going to take the rest of the world some time to catch up. Sending you peaceful vibes, love and harmony. Know that you are not alone.

Same link, page 4 of 13 (yes they are numbered but not on the pages, on the PDF file link at the bottom) POLICY BCBSNC will provide coverage for morbid obesity when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. See also Policy Guidelines. ............................................... Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read) https://www.bcbsnc.com/services/medi...id_obesity.pdf

http://mcgs.bcbsfl.com/ Note the timeline on this: 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows: <LI class=bulletedList-1>Malabsorptive procedures - alteration of the intestinal absorption limiting nutrients available to the body OR Gastric restrictive procedures - reduction in the capacity of the stomach thereby limiting the amount of food ingested. Gastric surgical procedures for the treatment of clinically severe obesity include: <LI class=bulletedList-1>gastric bypass where approximately 90% of the stomach is bypassed and reattached to the proximal jejunum OR gastric stapling, vertically banded gastric partition, or vertically banded gastroplasty where a proximal pouch of 30-60 ml and a one centimeter outlet are created by a row of vertical staples and a horizontally placed reinforcing band. WHEN SERVICES ARE COVERED: Effective January 1 2005, weight loss surgery is not covered for most contracts. Please refer to the individual member’s contract benefit language. NOTE: The primary care physician must provide a letter with facts supporting medical necessity, for review by the Medical Director. Certain surgical procedures performed for the treatment of clinically severe obesity may be considered medically necessary when ALL of the following conditions are met: The member: <LI class=bulletedList-1>meets the above definition of clinically severe obesity, <LI class=bulletedList-1>has been severely obese for at least five (5) years, <LI class=bulletedList-1>has attempted a physician supervised (by the primary care physician) non-surgical management weight loss program (e.g., diet, exercise, drugs) for six (6) consecutive months <LI class=bulletedList-1>has received psychological or psychiatric evaluation with counseling as needed, prior to surgical intervention; does not have a medically treatable cause for the obesity, (e.g., thyroid or other endocrine disorder). The following procedures may be considered medically necessary when the above criteria has been met: Vertical-Banded Gastroplasty (CPT code 43842) Vertical-banded gastroplasty was formerly one of the most common gastric restrictive procedures performed in this country but has more recently declined in popularity. In this procedure, the stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed, and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are uncommon. Complications include esophageal reflux, dilation, or obstruction of the stoma, with the latter 2 requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach. Roux-en-Y Gastric Bypass (CPT code 43644, 43846) Gastric bypass may be performed with either an open or laparoscopic technique. The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves a horizontal or vertical partition of the stomach in association with a Roux-en-Y procedure (i.e., a gastrojejunal anastomosis). Thus, the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant “dumping syndrome,” in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain OR vomiting. The dumping syndrome may further reduce intake, particularly in “sweets eaters”. Operative complications include leakage and marginal ulceration at the anastomotic site. Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures. These complications may include iron deficiency anemia, vitamin B-12 deficiency, and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the “blind” bypassed portion of the stomach. Long Limb Gastric Bypass (i.e., more than 100 cm) (CPT code 43847) Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures, which vary in the length of the alimentary and common limbs. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum, and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. While the long alimentary limb permits absorption of most nutrients, the short common limb primarily limits absorption of fats. The stomach may be bypassed in a variety of ways (i.e., either by resection or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the anastomoses. NOTE: Coverage of long limb Roux-en-Y procedures is limited to 150 cm. Adjustable gastric banding (i.e., Lap-Band Adjustable Gastric Banding System) (CPT code 43770, 43771, 43772, 43773, 43774) Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore, the rate- limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, the U.S. Food and Drug Administration (FDA) has approved one such device for marketing in the United States, Lap-Band (BioEnterics, Carpentiera, CA). The labeled indications for this device are as follows: "The Lap-Band system is indicated for use in weight reduction for severely obese patients with a body mass index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs or more over their estimated ideal weight according to the 1983 Metropolitan Life Insurance Tables (use the midpoint for medium frame). It is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives." Biliopancreatic Bypass with Duodenal Switch (43845) The duodenal switch procedure is essentially a variant of the biliopancreatic bypass. However, instead of performing a distal gastrectomy, a “sleeve” gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary limb. Preservation of the pyloric sphincter is designed to be more physiologic. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass (i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment). WHEN SERVICES ARE NOT COVERED: Surgery for clinically severe obesity is not covered when these services are excluded from the member’s contract benefits. Studies are needed to determine the long-term health outcomes of the following procedures, therefore the procedures listed below are considered investigational when performed for the treatment of clinically severe obesity: Biliopancreatic Bypass Procedure (i.e., the Scopinaro procedure) (CPT code 43847) Biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure. This procedure consists of the following components: <LI class=bulletedList-1>A distal gastrectomy functions to induce a temporary early satiety OR the dumping syndrome in the early postoperative period, both of which limit food intake <LI class=bulletedList-1>A 200-cm long “alimentary tract” consists of 200 cm of ileum connecting the stomach to a common distal segment <LI class=bulletedList-1>A 300- to 400-cm “biliary tract,” which connects the duodenum, jejunum, and remaining ileum to the common distal segment <LI class=bulletedList-1>A 50- to 100-cm “common tract,” where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel (i.e., creating a selective malabsorption). The length of the common segment will influence the degree of malabsorption Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy. Many potential metabolic complications are related to biliopancreatic bypass, including most prominently iron deficiency anemia, protein malnutrition, hypocalcemia, and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition (TPN). In addition, there have been several case reports of liver failure resulting in death or liver transplant. Mini-Gastric Bypass (no specific CPT code) Recently, a variant of the gastric bypass, called the “mini-gastric bypass” has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach, but rather the type of anastomosis used. NOTE: CPT code 43846 does not accurately describe the mini-gastric bypass, since this CPT code explicitly describes a Roux-en-Y gastroenterostomy, which is not used in the mini-gastric bypass. The following procedures reported as gastric bypass or gastroplasty are also considered investigational due to the lack of clinical studies to support effects on health outcomes: <LI class=bulletedList-1>jejunoileal bypass <LI class=bulletedList-1>gastric wrapping Garren-Edwards gastric bubble. BILLING/CODING INFORMATION: CPT Coding: 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) 43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption (investigational) 43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) 43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only 43772 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (investigational) 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) 43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy (may be done laparoscopically) 43847 Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (may be done laparoscopically) There is no specific CPT or HCPCS code to report mini gastric bypass. A laparoscopic approach is used with the mini-gastric bypass. The stomach is segmented similar to a traditional gastric bypass; the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. The mini gastric bypass is not based on its laparoscopic approach, but rather the type of anastomosis used. HCPCS Coding S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline ICD-9 Diagnoses Codes That Support Medical Necessity: 278.01 Morbid obesity REIMBURSEMENT INFORMATION: Bariatric surgical procedures are limited to individuals 18 years and older and are reimbursed based on the procedure performed and not the surgical technique used (e.g., microsurgical, laser, laparoscopic). PROGRAM EXCEPTIONS: Federal Employee Program (FEP): Follow FEP guidelines. State Account Organization (SAO): Follow SAO guidelines. DEFINITIONS: Biliopancreatic bypass: gastric restriction rerouting bile and pancreatic juice to the distal ileum. Garren-Edwards gastric bubble: a free-floating intragastric device made of elastomeric plastic is placed in the stomach via a gastroscope, used for reducing stomach capacity. Gastric wrapping: the stomach is folded over on itself and a full stomach wrap, i.e. polypropylene mesh, is applied to limit gastric volume. Gastric banding: a synthetic band rather than staples is used to divide the stomach into a small upper pouch and a lower portion). Gastric bubble: see definition of Garren-Edwards gastric bubble. Jejunoileal bypass: shunts food from the jejunum into the ileum, bypassing the small intestine. Morbid obesity: defined as a body mass index (BMI) of 40 kg/m2 or greater. Satiety: the quality or state of being fed or gratified to or beyond capacity. RELATED GUIDELINES: Gastric Bypass Revision, 02-40000-11 OTHER: Other index terms for gastric surgery: Adjustable gastric banding Bariatric surgery Gastric bypass surgery Lap-Band System Mini gastric bypass Billroth II Long limb gastric bypass Roux-en-Y Scopinaro Vertical banding REFERENCES: <LI value=1>All-plan survey (Blue Cross Blue Shield plans) <LI value=2>American Academy of Medicine CPT Coding (current edition) <LI value=3>Blue Cross Blue Shield Association TEC Evaluation (12/88), 2003 <LI value=4>Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. BCBSA TEC Assessment Program, 2003; 18:1-25 <LI value=5>Blue Cross Blue Shield Association-Surgery for Morbid Obesity (7.01.47), 12/14/05 <LI value=6>DeMaria, E J, Sugerman, H J, Meador, J G, et al. High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery 2001:233:809-818 <LI value=7>First Coast Service Options (FCSO) Medical Policy - surgical Management of Morbid Obesity, LCD #L14600 (01/01/06) <LI value=8>Guidance for Treatment of Adult Obesity, American Obesity Assoc., 1998 <LI value=9>Hayes Medical Technology Directory - Laproscopic Bariatric Surgery - us.lapa0008.2005 (11/03; Update report 12/05) <LI value=10>Hayes Medical Technology Directory - Obesity Management, Surgical Approaches OBES0802.03 (10/99; updated 07/27/02; updated 04/04/03) <LI value=11>InterQual Care Planning Criteria: General Surgery; Weight Loss Surgery GS-23 (2003) <LI value=12>National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity Statement (March 25-27, 1991) <LI value=13>Rutledge MD, Robert. “The Mini-Gastric Bypass: Experience with the First 1,274 Cases”; Obesity Surgery 2001; 11:276-280 <LI value=14>St. Anthony’s ICD-9-CM code book (current edition) U.S. Food and Administration (FDA) Talk Paper, FDA Approves Implanted Stomach Band To Treat Severe Obesity, T01-26, 06/05/01 COMMITTEE APPROVAL: This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 04/27/06. GUIDELINE UPDATE INFORMATION: 10/15/99 Medical Coverage Guideline developed. 09/15/01 Various revisions. 01/01/02 Coding changes. 10/15/02 Annual review. Added Roux-enY anastomosis or vertical-banded as covered services. Added biliopancreatic bypass with duodenal switch and very long limb gastric bypass procedure (e.g., greater than 100 cm) as non-covered services. 05/15/03 Revised to clarify coding of the various procedures; criteria revised and is consistent with Inter-Qual criteria. 09/15/03 Coverage criteria for psychological testing/counseling revised. 10/15/03 Reversed investigational status for CPT code 43847 and provided coverage criteria for long-limb Roux-en-Y procedures up to 150 cm. 01/01/04 Annual HCPCS coding update. 04/01/04 2nd Quarter HCPCS coding update; added S2082 and S2083. 07/15/04 Scheduled review; no changes. 01/01/05 HCPCS coding update. Added 43644, 43645, 43845, S2082, and S2083. Revised descriptor for 43846, and deleted S2085. 05/15/05 Unscheduled review of the non-covered statement for laparoscopic adjustable gastric banding (Lap-Band); coverage statement unchanged. 01/01/06 Annual HCPCS coding update (added 43770-43774; deleted S2082). 04/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references. 05/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references; added age limitation of 18 years and older. Private Property of Blue Cross and Blue Shield of Florida. This medical coverage guideline is Copyright 2006, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

Hi JenL37. Welcome.

Because I am bored and want to help as many people as possible today so they do not feel my frustration. A) Do not assume that customer service knows your coverage. They are misinformed at times. Getting mad at your insurance company's customer service representative is about as effective as cutting off your nose to spite your face. C) Always know more than them. D) Have a notepad availabe and jot down the person's name as they say it, the time and a summary of your conversation. E) Have a plan B, C, D... F) I have not come across anyone who did not require the procedure to first be deemed Medically Necessary by supporting documentation. ........................................................................................... Who does what and always check what KIND of insurance you have..PPO? HMO? because that will determine coverage. Alabama Blue Cross and Blue Shield https://www.bcbsal.org/health/important/bariatric.cfm#10 Blue of California https://www.blueshieldca.com/hw/articles/hw_article.jsp?articleId=HWHW252819 Connecticut, Anthem BCBS http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034084.pdf Delaware http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034084.pdf This site covers multiple states. PDF] Medical Policy - SURG.00024 - Surgery for Clinically Severe ... ... Policy Statement Medically Necessary: Gastric bypass with a Roux Y procedure up to 150 cm, laparoscopic adjustable gastric banding (the Lap-Band ® ... www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034084.pdf - 2006-11-11 - Text Version

Hello All: At this point I consider myself the guru to the guru of BCBS's policy for gastric surgery. I will share everything I know. (background, I have been at this since September) an exclusion in the policy reads like this: Blue Care for Large Groups Member Handbook: Section 15: Covered Services Introduction "Covered Services Expenses for the health care services listed below will be covered under the Group Plan only if the services are: 4. not specifically limited or exluded..." Section 22: Exclusions and Limitations "Exclusions 49. Weight control services including any service to lose, gain, or maintain weight, including without limitation: any weight control/loss program; appetite suppressants; dietary regimens; food or food supplements; excercise programs, equipment or memberships; or surgical procedures." ..........................................SNIP That is what my policy reads like. I'm going to my employer to the medical insurance committee and appealing for a purchase of a rider to specifically include gastric surgery ( Lap Band ). That meeting for me is January 31st. My position is I pay for insurance, I have a condition my physician has deemed medically necessary, the insurance I pay for does not cover it because my company purchased that exclusion in the contract. Now on to the other questions and comments. About that "investigational" argument and that it is NOT covered because it is still investigational. That is incorrect. You want to call them back and speak to a supervisor and tell them you were told it was excluded because it is investigation and referr them to this memo from BCBS Corporate which changes it out of investigative to approved. This is the Press Release regarding the procedure from BCBS in November of 2006, it reads: http://www.bcbs.com/betterknowledge/tec/press/ The following Assessments and Special Reports were acted on at the November 2, 2006, Blue Cross and Blue Shield Association Medical Advisory Panel (MAP) meeting: Laparoscopic Adjustable Gastric Banding for Morbid Obesity The MAP concluded that laparoscopic adjustable gastric banding for morbid obesity meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. Articles from BCBS about gastric surgery: http://www.bluecares.com/about/search.jsp?query=gastric Find your BCBS company for your state where you can go to the search engine and look up GASTRIC for hits on information for their policy. http://www.bcbs.com/coverage/find/plan/ Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read) https://www.bcbsnc.com/services/medical-policy/pdf/surgery_for_morbid_obesity.pdf

and I get HOPE from all words I read. Anything is better than being where I am right now, 360 lbs.

43770 is what I'm told is the code. Print out from the site I gave you and give it to the doctor's office. They'll know what to do.

BILLING/CODING INFORMATION: CPT Coding: 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) 43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption (investigational) 43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) 43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only 43772 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (investigational) 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) 43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy (may be done laparoscopically) 43847 Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (may be done laparoscopically) There is no specific CPT or HCPCS code to report mini gastric bypass. A laparoscopic approach is used with the mini-gastric bypass. The stomach is segmented similar to a traditional gastric bypass; the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. The mini gastric bypass is not based on its laparoscopic approach, but rather the type of anastomosis used. This on the Blue Cross Blue Sheild page: http://mcgs.bcbsfl.com/index.cfm?fuseaction=main.main&doc=Surgery%20for%20Clinically%20Severe%20Obesity

It is in the individual policies. What one company may have purchased could vary from another company. It's like the coconut shells game. Guess which plan the surgery is under!

Here is what I found out on BCBSFLorida. My WLS is an exclusion and that is why my claim is denied. I took it to a level two appeals within BCBS and it too was an adverse finding for me for the same reason. The language in my contract specifically states that WLS is not a covered benefit...not only that, no meds, no memberships, no medication..NOTHING...NADA ...to lose weight. That is pathetic. *I believe adversities have seeds of personal growth in them. I look for those seeds during duress. I have found a field in BCBS's policy towards obesity healthcare. Yes, I will contact the newspaper. Yes, I will contact this person "Abramson" if I have the name right, forgive me if I don't but will be certain I do when I mail off my letter to him. BCBS is reviewing its weight loss provision in April of this year. I ENCOURAGE ALL WHO HAVE BCBS TO WRITE LETTERS. Meanwhile: January 31st I have a meeting with the School Board Insurance Committee. They have the opportunity to purchase a rider for my surgery. I am appealing to them as a last recourse. I have requested my file from BCBS that they used in my determination, there will be a team of folks there and I intend to not just educate them but EDUCATE THEM. If they don't approve the rider, they will atleast walk away with a knowledge of life as a morbidly obese human. Plan B, going to Mexico. Nothing will stop me from getting this surgery. I feel like I'm fighting for my life and this surgery is my Lorenzo's Oil.

They are everywhere. In the newspaper and especially on the television in the wee hours of the morning! Magic solutions to losing weight. Rock your way to tight abs! One pill does it all and if you order NOW you get two for one! I'm so sick of infomericals I could hack!

Congrats for staying strong. I'm happy that your friend finally came around and will be another support source for you.

What is CDHP? I missed something, explain what you mean: ...but you see.. the SAME policy, same provider, same plan gets very different answers by bcbs.... Thanks Tracy.

how will your boyfriend handle you? The same way my husband will, with both hands or maybe one because he won't need two. (and I'll be smiling) Wishing us both a healthy new life.

What does not compute for me is that I met the requirements set by BCBS corporate but BCBS of FL and my policy specifically denies coverage of gastric surgery. The clause that denies coverage is one simple sentence on my plan, "...not a covered benefit...". Other BCBS plans do cover this. The BCBS plan that does cover gastric surgery requires it be medically necessary. This seems like a contradiction in terms. (to have the surgery you must meet the criteria of it being medically necessary. Now that you met the criteria of it being medically necessary, it doesn't matter because we aren't going to cover it anyway) This isn't computing to me. At what point does my doctor's words "medically necessary" mean something??? He even wrote a very lengthy letter to my insurance. This isn't making sense to me.

Thanks Tracy!! .......................................................................... Anyone have an idea what policies generally stand for "medically necessary"????

Share your best moments here.:clap2:

Thanks for this post. I just finished with my second Appeal, next is state level. I will go through that unless I find success with my employer. I read my contract and there is an exclusion to gastric surgery. It's very clear. But my doctor does support me in doing so and has written letters and provided clinical information. My insurance company told me that my employer could purchase the rider that included the surgery. I thought he was just trying to sell more insurance. So I called employee benefits and sure enough, the supervisor said "we get requests like this all the time for things like infertility...". I'm now going full on with my employer. I pay for insurance to cover me medically. I will let you know what I find out tomorrow. Best of luck.

Great news for you all. I remain hopeful for the future. Denied today, second denial but reading these gives me great inspiration to keep going.