bc/bs al

[Grammy271 1]

Anyone have insurance with bc/bs alabama? If so I would like to know what they required for lap band surgery.

[sassy k's mommy 1]

are you with State Employees??? I am so this is what I had to do:

You might have to do a 6 months weigh in at your primary care doctor. I had to get my primary care physician to send a referral to my doctor. I don't have to do the six months. Which then Dr. Mora's office to call me and set up an appointment to attend the seminar. I paid the $100 for the seminar. I am required by my doctor to attend three support groups. I have one more to go. Once you attend the seminar you will be contact to schedule your consultation with Dr. Then you will then find out what test you will need to be done. You will have to talk to a pyschiatrist, cardiologist, pulmonary doctor, nutritionist and sleep study.

I will have to pay out of pocket about 1200.00

Edited September 28, 2010 by hollyboyd63167

[stateofzen 46]

First, make sure your employer hasn't excluded the surgery from coverage. I had BC/BS of Al under my employer and it was excluded by my employer, so I had to switch to my husband's BC/BS AL plan. Crazy.

They require a full 6 month medically supervised diet (it ends up being 7 months because the first visit doesn't really count)-- you have to go every month to your doctor and they have to chart about your weight and diet. You cannot skip a month or you have to start over.

They require a 3 year weight history of over 40 BMI, or 35 with 2 major complications (diabetes and high blood pressure, for example). I just had to get my doctor's records with weight faxed in for past 3 years.

Once I did those things, I got approved immediately. Like, within 15 minutes of the doc's office submitting my stuff and they have been a dream once I met the criteria. Cost me some of the pre-op visits out of pocket, and $150 copay for the surgery. Not bad.

[Scarred4Life 1]

I also have BCBS of AL.. They required a 5 year weight history from me, and the 6 month supervised diet. again as stated above - you have to go EVERY month.. Jan, Feb, March... not just every 4 weeks - or you have to start all over again. I had to have a psych eval ($150) and nutritional consultation

($500). Neither which applied towards my deductible. My PCP had to write a letter of recommendation as well as visit notes for every month. My last visit with my PCP was 8/28.. and my surgeons office submitted the paperwork and had approval by 9/2. But they have a disclaimer that they can take up to 30 days... Another thing - dont know if it will apply to you - but if you are a smoker, they state you have to have quit for 6-8 weeks.

[Grammy271 1]

Thanks for the info. My insurance does cover lapband and I now know that I have to do 6 months supervised weight visits, nutrition consult, pysch consult, sleep study, lab work, stress test. Then submit for approval. Time to get started and looking forward to the journey.

[stateofzen 46]

Thanks for the info. My insurance does cover LAP-BAND® and I now know that I have to do 6 months supervised weight visits, nutrition consult, pysch consult, sleep study, lab work, stress test. Then submit for approval. Time to get started and looking forward to the journey.

It will fly by, I promise! It seems like such a long wait when you first hear 6 months, but my experience was that I was able to use that 6 months to get myself in the right mental state, start a gentle exercise program, etc. Treat it like an opportunity :rolleyes2:

A tip about the psych consult: My surgeon said "here, go to this guy". But "this guy" wasn't covered by BC/BS. So I found a psych who did the eval who was in my plan and instead of paying $350 for the test, I paid a $40 copay. I don't know where you are in AL, but private message me if you are in the Birmingham area and I'll tell you the psychologist's name.

Good luck and you'll be banded before you know it!