Who has had the most success with a FEHB--which plan. Same questions for plastics. Which plan has the bestcoverage? Thanks for your help

I'm going through the process now. BCBS FEP is my secondary coverage, with Unicare through my job the primary. BCBS tells me they do not cover lap bands. Has anyone had success with appealing?

i have blue care network.they cover lap band if you meet the criteria, which i have not been approved yet i go see the surgeon on the 27 so hopefully he finds that i need the procedure.

Is your plan BCBS for federal employees? They seem to have different criteria than other Blue plans.

i have blue care network for federal employees......in michigan but you have bcbs so that must be the difference.

Hi. I have Anthem FEP BCBS HMO (OH). Is that a whole different thing? According to a call made to them (by me 3 different times and surgeon's office once), they DO cover the band and ALL testing associated w/it. So far all the preliminary stuff has been paid and we are getting close to submitting to insuance for approval. BCBS actually sent me a fact sheet on what's covered as far as wls goes (will post if anyone wants to see, it's actually pretty good). Has anyone tried to go thru the appeal process (if denied by a Federal insurer) and contact their elected officials also? I used to work for a public affairs office in DC for a federal agency and found that seems to get a little more attention. I'm planning on going to my congressman, both senators, & OPM if I get turned down. I figure, bring out the big guns in the beginning so no more time is wasted. A good website is http://www.obesityhelp.com. I think it's Ohio based, but you can search other states too on different topics. Wish me luck, and good luck to everyone else!

DH is a federal employee, he has GHI FEHB as his primary plan. They did not cover the lapband. We appealed all the way to Washington and they still would not cover it. Both DH and I got our lapbands through my health insurance HIP Prime. I have no idea about plastics, because DH was banded in April and I was banded 7/5/06. Good luck!

Have you checked out First Health (MailHandlersBenefitplan - MHBP)? This is the ins. I had when I was banded. Quick approval and wonderful coverage.

Hi again.....Well hopefully it is state specific. Here's what Anthem voluntarily sent me. Yes, voluntarily! Did they specifically say the didn't cover the band? Now I'm wondering.....Will TRY to upload this pdf thing.....

anthem lap band policy.pdf

hmmmm MHBP.....How are they w/everything else?

Ok I'm confused....what are "plastics"? I know the band is plastic.....

I have Athem BCBS state . Good coverage fast aproval.

I am in the state of Virginia. Good Luck to all of you.

MHBP.....How are they w/everything else?

Horrible!

Thats why we left the plan. We'd been with this plan for 10 years and each year the plan would change - for the worst.

The last year we had this plan is the year I had my band (2004). No dental and had to pay a ded. for prescript's... with 3 kids we needed a plan that had these coverages!

'Plastics' is a term used for plastic surgery.

Some ins. comp's cover the removal of excess skin for weightloss surgery patients - also know as plastic surgery!

I'm learning more about this than I wanted to learn. Apparently, the local HMO plans that are associated with FEHB use the medical policies of their local BC/BS affiliates. All of those that I've looked at in fact do cover lap band. However, the national BCBS PPO FEP plan uses national policies. The national policy, however, states that there is not enough US research to support approval of the band. This is in direct contradiction to the policies of the affiliates.

So now I'm in the uncomfortable position of BCBS having stated that I meet the medical criteria, but they simply won't cover the band. They will, however, cover the gastric bypass.

Advice?

GEMOM: what state are you in? Do you have PPO or HMO. From what I hear in Ohio, they're pretty good w/the Anthem bcbs fehb ppo approval. I have a feeling it varies state to state. And who says we don't need healthcare reform. Actually, I'm going to stop before I get on my soap box on that one! Alexandra has a GREAT post on convincing the ins co to cover band vs bypass. I saved it to a word file so I'd have easy access. Personally the whole thing sucks!

lap band appeal ltr.doc

I'm in Illinois, and we have the national standard option BC/BS FEP plan, PPO. The policy has a specific statement that it covers "gastric bypass and gastric stapling procedures", and they tell me that it doesn't cover lap band. However, I learned today that my other insurance, Unicare, has approved me for lap band. HURRAH! Otherwise, I was all set to get my husband to change at the next open season. :confused: :clap2: