...she stated that some insurances require the 6-month diet and weight loss period. Does any with this insurance know if this is a requirement and also for an idea for out of pocket total cost. My insurance will pay for 80% with a lifetime max of $16,000.00 -- any help is greatly appreciated!

Forgot to mention that I'm from California.

...she stated that some insurances require the 6-month diet and weight loss period. Does any with this insurance know if this is a requirement and also for an idea for out of pocket total cost. My insurance will pay for 80% with a lifetime max of $16,000.00 -- any help is greatly appreciated!

Yes I have the same insurance I live in Los Angeles , I really think its up to your surgeon and they submit it to the insurance company . It took only 2 months to get approved without all the red tape . If you live in the area email me and I can get more in detail . I have a friend that have a *** she had lots of risks factors and was in great need for the Lapband , they made her go to class after class before they even consider her for surgery. I had no problem.

I have PA A BCBS - no 6 month required for me.

Even thought my doctor's surgery coordinator told me it is - I think they want patience to have 6 months to get more money from the insurance. But I had a nightmare of a surgery coordinator. She might be just one bad apple :-)

I would suggest checking twice with A BCBS. They have 25 page doc ( at least PA A BCBS) and it does not mention any 6 months diet or 5 year weight history ( yes the coordinator insisted to have it as well)

I submitted ONLY what insurance required. Which was a request from my surgeon for approval - 2 page form ( 2 last pages of that 25 page doc the insurance pointed me to)

i have anthem BCBS CA. i called the customer service line and they sent me their policy. no pre-op diet other than the required psych, dietician (they will authorize up to 6 additional classes with the dietician if you need it), seminar, a few others ekg and such. they authorized me in one week.

Hi there,

My blue cross PPO rep told me that they want to see 6 months of continuous weight loss effort within the last 18 months of your doctor submitting the request for approval. Good luck with everything.

I have Anthem also. I live in Alabama. No 6 month diet plan. I called customer service and got all the requirements before I ever went to my surgeon so I knew I had to pay 20%, psych eval once I got all that done I gt approval 6 days later. Good Luck!!

Thanks so much for all the info! Trying not to rush things but I've been living with this "issue" for most of my adult life... it's been so long of a journey and I've come to a place where I am now ready to make the "lifestyle commitment".

I am a California with Medicare as primary and Anthem Blue Cross as secondary (and "Tricare brings up the rear.") I had no issues at all with this arrangement. I just provided the insurance information and the staff took care of it all. I have not received statements of what the various insurers paid, and it is 7 weeks later, so I can't be sure there are no leftover co-pays, but no one has mentioned them to me..

I also have Anthem BC/BS. Doc’s office handled all the paperwork for me, and I was approved with no 6 month diet in about 8 days!!! My first doctor visit was June 3 and my surgery is scheduled for July 28.

I suggest you let the doctor do all the contact with the insurance company. I called Anthem several times before finding a doctor and got different answers every time. One time they said I had to do the 6 month diet, another time they said I didn’t. After I was certified, I called Anthem to see if they would cover any travel expenses since my surgeon is out of state, and they actually said the surgery wouldn’t be covered at all! When I explained I had already received pre-certification, the person on the phone said, “Well, I’m looking at your policy and it simply isn’t covered.” She was wrong, but this is why I suggest you let the docs staff, who do this all day every day run the traps for you. I think every employer has a different level of benefits even though it’s all Anthem, so you really won’t know for sure until the doctor requests precertification.

Good luck!

Hello ,

I have BC/BS ppo they never told me to loss any weight . It just tuck a about 8 months for them to approve me. Once i got approve I got the lapband. Till today I pay out of my pocket about $775.00

Hello ,

I have BC/BS ppo they never told me to loss any weight . It just tuck a about 8 months for them to approve me. Once i got approve I got the lapband. Till today I pay out of my pocket about $775.00

i also have CA anthem bcbs. i just had my first consultation yeterday. there was no required pre-diet however before they would submit pa request. i have to see the psych - nutritionist-gi xray-sleep study. this facility requires that i do a pre class at $400 and $800 post-op. its about 1450 in out of pocket fees. i dont really know if the additional cost only apply to this facility because its my first consult but my i know my insurance covers 100% of the procedure.