I'm trying to appeal to BCBS of Oklahoma for the lap band & am interested in BCBS's coverage of it in other states...anybody out there know???

I was just approved through Blue Cross Blue Shield Federal Employee Program, I am having my band 2/22/07. It was submitted to them 1/31 the approval was pretty fast.

Hi, I had my surgery in April (self pay) and now my Mom is trying to, she is scheduled for 2-14-04 and has Federal Blue Cross and Blue Shield.

I am wondering how you got pre approval. They keep telling me and my dr's office that they will not pre approve. Anyone have any info.

Hi, I had my surgery in April (self pay) and now my Mom is trying to, she is scheduled for 2-14-04 and has Federal Blue Cross and Blue Shield.

I am wondering how you got pre approval. They keep telling me and my dr's office that they will not pre approve. Anyone have any info.

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I had my surgery on 1/15. BCBS Fed is my insurance. When we called before my surgery to get the preapproval, they told me and my dr. they no longer do preapprovals, whether it be GNY or lapband, that you have to have the surgery and then submit your claim. In my case, that meant paying as a self-pay upfront. We are now waiting on approval.

What they did tell us were the conditions that you had to meet, but again, they couldn't make a determination until after the surgery. The conditions you had to meet were a bmi of 40 or over, or a bmi of 35 with obesity-related ailments, 5 years of conservative dieting, i.e. ww, atkins, exercise.

I asked our rep if you had to have the diets documented b/c I have done ww enough to know it like the back of my hand (just didn't succeed for very long) and didn't attend the meetings. She said no. I asked her did it matter that I didn't have medical records with my primary dr. indicating I had dieted or was trying to lose weight (b/c if I'm not sick, I don't go to the dr.), she said no.

So because I had a BMI over 40, had dieted my heart out for the last 10 yrs, meeting their conditions, both dr. and I felt confident that BCBS Fed would pay. Just found out this morning that my anesthesiologist bill, $1,000, was denied b/c ins. said it was not necessary. Whatever that means. The rep volunteered to have that claim re-reviewed. The claim for my surgeon and hospital are still under review w/out a determination.

I don't know if this helps or not. I wish you good luck!

:clap2: :tea: :high5: :peace: :whoo: :rockon: :wow2: :grouphug: :humble: :lock1: :hug: :cheer2: :Banane20: :Banane27: :Banane57: :Banane34: :woot: I WAS APPROVED!!!!!!!!!!!!!!!!!!!!!!!!!!!!

they will call me tomorrow to schedule a date!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Congratulations!!!!!

holy moly!!:faint: My surgery date is February 27th!!!!!!!!!! That's less than two weeks! Now All I have to do is survive the pre op. liquid breakfast, liquid lunch and small protein supper. (I may switch the supper with the lunch for the sanity of my co=workers...:mad: )

holy moly!!:faint: My surgery date is February 27th!!!!!!!!!! That's less than two weeks! Now All I have to do is survive the pre op. liquid breakfast, liquid lunch and small protein supper. (I may switch the supper with the lunch for the sanity of my co=workers...:mad: )

holy balls that was fast! :clap2:AWESOME!:clap2: how exciting! i bet the liquid diet will be a breeze---look what you have to look forward do! SWEEEEEEEET!! keep us posted!

do anyone no if i can use curves for 6 month program or woman work out:phanvan

Approved, what a great word.

:update:

Hey, well I was banded on Valentines Day (feb 14).

I did it with the thought they (bc/bs) would approve. Dr's insurance thinks they will pay also. Guess we will know in a couple of months.

I have three of the co-morbidy requirements. one is Sever sleep apnea. I lost 18 lbs on the pre band diet. Hope I can lose that much the first month after band. I have felt really good. My port area is sore and where they repaired my reflux area. Guess they did lots of poking around there.

congrats to all the APPROVED people!

Do not be suprised if the insurance denies the claim. My girls insurance company said they would not pay after the opperation was Pre-approved, checked by the doctors office and hospital for approval, checked by myself for approval, and everybody was happy. The operation went well (she had RNY) and it was several weeks later she recived a bill from the hospital for $68,000.00 to say the least was upset. The hospital started to ask for money and things got ugly. We were finaly told that it was a delaying tactic to not pay by the insurance company. That was why the doctor ask for and recived $5000.00 cash before the opperation was performed. The insurance company finaly paid.

So, I was turned down by my insurance company - Empire BC/BS, in NYC.

Apparently, my BMI is too high for their criteria for LB; they claim it's not clinically proven to be valuable at my size (BMI 58, I think). It's slightly disastrous, because my surgery was scheduled for 3/15, and I've arranged my work schedule around that date (very difficult to do, high stress profession blah blah blah). And the surgical coordinator is away until 2/28 - I should be starting the preop liquid diet the next day.

So now what do I do? I am going with Dr. Fielding at NYU in NYC. Empire BC/BS said they'd send me a rejection letter with details for appealing.

Any advice?

So, I was turned down by my insurance company - Empire BC/BS, in NYC.

Apparently, my BMI is too high for their criteria for LB; they claim it's not clinically proven to be valuable at my size (BMI 58, I think). It's slightly disastrous, because my surgery was scheduled for 3/15, and I've arranged my work schedule around that date (very difficult to do, high stress profession blah blah blah). And the surgical coordinator is away until 2/28 - I should be starting the preop liquid diet the next day.

So now what do I do? I am going with Dr. Fielding at NYU in NYC. Empire BC/BS said they'd send me a rejection letter with details for appealing.

Any advice?

PLEASE APPEAL AND GO TO WWW.OBESITYLAW.COM

I'm trying to appeal to BCBS of Oklahoma for the lap band & am interested in BCBS's coverage of it in other states...anybody out there know???

Hi there! I have BC/BS PPO of New York and was appproved with no problems on June 1st, 2006. I had my LapBand surgery on June 13, 2006 and Iam now 8 1/2 months out and Iam down 57 pounds!

My doctor and his staff have said that Empire is the best and I agree! I have had no problems with them. Their medical management department has been very easy to work with when it comes to my claims and any bills.

Good Luck to you!

Lisa

So, I was turned down by my insurance company - Empire BC/BS, in NYC.

Apparently, my BMI is too high for their criteria for LB; they claim it's not clinically proven to be valuable at my size (BMI 58, I think). It's slightly disastrous, because my surgery was scheduled for 3/15, and I've arranged my work schedule around that date (very difficult to do, high stress profession blah blah blah). And the surgical coordinator is away until 2/28 - I should be starting the preop liquid diet the next day.

So now what do I do? I am going with Dr. Fielding at NYU in NYC. Empire BC/BS said they'd send me a rejection letter with details for appealing.

Any advice?

My BMI is 61. I've had two surgeons tell me I need to get that bad boy number down for my own health's sake and to shrink my liver for the surgery.

you will read about detoxing on here. Detox diet to purge your system of the nasty junk in your liver (fatty stuff). I have to do this anyway and I'm self paying and getting my sugery.

Appeal that decision but the criteria they may have you under the thumb on. I wouldn't give up because I think the person who told you there was no proof LB was beneficial at your size was full of it and showed what little they did know when they made that comment. (people can be so self serving to their company..anyway) What idiot would say a weight loss surgery would not be beneficial to a very severely obese person?????

HELLO! That's like saying the patch won't work for a really super heavy smoker.

Check out the BCBS thread on here. I have mega posts from my appeals process. I have a specific exclusion in my contract that does not cover weight loss surgery "no matter what" but I still appealed. Feel free to tap my info posted there.