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 have Fed Employee BCBS and they said they cover now in 2007. I'm wondering what the co-pays wind up being?? Anyone know?? I know each plan is different but we have the higher option of the insurance. If you have it please let me know what to expect.

I have BCBS TN Premium PPO and my co-pay was $250. No clue about the fills.

T

I have Fed Employee BCBS and they said they cover now in 2007. I'm wondering what the co-pays wind up being?? Anyone know?? I know each plan is different but we have the higher option of the insurance. If you have it please let me know what to expect.

I have decided to get the lapband. I meet with my doctor on monday. I have BCBS fed. I have called numerous times because a lot of times people tell you different things. I live in MD and my husband works for the federal government. Our group number is 105 (standard options plan). I have been told by evey single customer rep i speak to that it is covered. If I use one of their preferred doctors they will pay for 90% of the cost. The only thing out of my pocket is the 10% and my decutable of $250. If I use someone outside of their network it is 80/20. I even verified this with a different surgeon I was talking too. His office contacted BCBS fed and got the same info. The reps have also been extremly helpful and nice with me.

I also made sure there were no qualifying things such as a pre diet, psych eval. etc. All I have to do is meet the norm. requirments. 35+BMI.

If you have BCBS fed. it is very easy to look up one of their preferred surgeons. You go to their website: fepblue.org and go into preferred provider directory. Enter in your zip or location. You have to look under surgery or general surgeons and just kind of go through and see who does bariatric surgery. Also to the right of the box you will be filling in there is a little box that says preffered canters or hospitals something like that and it has BCBS Fed bariatric centers. So I would guess if you picked on of those you would be even better off.

I hope this helps. I will post after my appointment on monday to let you know if the insurance will go as smoothly as it sounds.

We have the exact same insurance. My husband is a fed employee also and group number 105. So at least I know what to expect. Thank you very much. I had a feeling it was going to be a lot easier than it was a couple of years ago.

Good luck to you. I'm going ahead with it.

i have plan 104--maybe the difference is that i have single plan.

i am glad to know the info you guys have given. i finally got to see the surgeon last thursday after months of prep work such as support group meeting, psychologist approval and consultation with a dietician. and they lost some of my paperwork so it has been a long haul. now it is in the hands of the insurance. i am going to one of their Centers of Distinction so i hope i can get this done soon.

keeping my fingers crossed.

I can't seem to get onto the page on bcbs of Centers with distinction because when they go to a pdf acrobat reader file my computer sends an error message. I'll have to check it out on another computer to see if the one I'm going to is. I'm sure they probably are because they are one of the top bariatric surgrery centers in the country.

I can't seem to get onto the page on bcbs of Centers with distinction because when they go to a pdf acrobat reader file my computer sends an error message. .

I called BCBS and spoke with a representative that was vaguely aware of a change in the policy. She was very helpful and was able to direct me, while online, on how to find the policy so we both could read the changes. In NC, the policy for surgery for morbid obesity HAS changed and "gastric banding," as they call it, (the only one in the U.S. that is approved is the Lap Band) is now approved, providing you qualify.

I can't seem to get onto the page on bcbs of Centers with distinction because when they go to a pdf acrobat reader file my computer sends an error message. I'll have to check it out on another computer to see if the one I'm going to is. I'm sure they probably are because they are one of the top bariatric surgrery centers in the country.

in oregon the bariatric centers of distinction (according to BC/BS FEP) are:

Legacy Good Samaritan Hospital Portland

OHSU Oregon Health Sciences Portland

St Charles Medical Center of Bend Bend

Hey thanks for the info. Yes, I'm going to Legacy Good Samaritan Obesity Institute. Do they pay more if you go there or do we just pay less.

now that is an interesting question. i dont know.

usually when bc/bs has a "preferred" physician they work out a deal where the doctor will accept less money. now whether a "center of distinction" is synonomous with "preferred" i dont know.

but in either case the patient ends up paying less--10 percent plus deductible versus 20 percent.

Hi I am new here but excited about finding this site. Its been very helpful. I have BC of Calf and it is supposed to cover 90% but they want diet history and so on. I have an appt with the dietician on the 26th then all my information will be submitted to the insurance co. I did write a letter to my insurance company which will go with all my other records for review. Hopefully they will approve it. Its so very hard to wait. Good luck to everyone that is waiting for approval.

singdeborah & bhabydoll: I also have Fed BCBS plan 105. I have made 2 phone calls though & cannot get a person who knows ANYTHING about getting lap band approved. Both reps from BCBS just read word for word what is written in the handbook. Page 48 they keep repeating to me. Page 48 just says that it is covered, I want/need to know if I have to have a diet diary of like 6 months or more or a psych eval or any of the sort. I have not met with a surgeon yet--I'm just attending the seminar next week but have a packet of info that needs to be completed & these questions are in the packet. I'm nervous yet excited that this may be easier than I thought (insurance approval) but afraid that there is "more to the story" and the handbook just doesn't cover any of that info. ???

Good luck to everyone begining this process--may it be short & sweet!

Hi- I have bcbs of GA- I had to jump through a couple of hoops- but it was covered- my doc had to write a letter stating that other diets had failed, went to a head doc, went to a dietician, and a seminar for the surgery- but that was a breeze. Don'tgive up hope- keep fighting, see if your doc office can help. Good luck

Susan

I'm discouraged already and haven't even begun the process.

I attended the seminar last night but was told that the surgeon refuses BC/BS Federal (group 105) as they do say that they cover banding but will not giver prior authorization or approval...just get it done then send in the claims...apparently, when that is done, BC/BS is not paying! I'm so disappointed. Anyone with this plan have same problem? I cannot afford to self-pay at this time.

TIA!

I'm Empire BCBS in NY. I received my final results from my Apnea testing and I do have mild apnea. I have to say that I've never been so happy to hava a malady! I hope the Pulmonologist will fax a letter confirming this to my surgeon tomorrow....and then we submit! Whew.

So, BMI over 40, over 5 years morbidly obese, psych eval, nutritional eval, 6 months "letter" of progress from PCP, Esophogram, EKG, Echocardiogram, letter from chiropractor re:osteo, CT scan of fatty infiltration of my salivary glands and liver (yes, even my glands are FAT), PCP letter of failed diet attempts, letter of support from my Endocrinologist (med controlled hypothyroid BTW). Hoping this will suffice. I did also have gestational diabetes but I don't think it counts, as it is not currently KILLING me.

I'm a little sarcastic this evening..but I am so beyond excited, nervous, anxious......

Please send me some good vibes.

Oh, BTW, after 2 weeks of daily, intense excercise and dieting...I gained a pound according to my PCP's scale. I wanted to cry.....I need this help so badly.

Jill in NY

BMI 41

246/???/175

Dr. Mayer, Huntington NY