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???

Hello everyone!! FYI I have BS of California Shield Spectrum PPO plan 750, I called them today and they told me that they just started covering the Lap Band March 29th. I am so excited! They also said that a Dr needs to say its Medicaly necessary. (hello of course they will!) Then u need to meet with a nutritionist and have a psych eval. No 6 month supervised diet. Thank god! So just wanted to let everyone know! Wish me luck hopefully everything will go smooth from here on out!

Hi, welcome to the club. Hope it all turns out just the way you want it. One word of caution, you need to call a BS rep, have him/her guide you to the website, download and print you particular BCBS corporate policy for surgery for morbid obesity. Read it carefully and follow ALL instructions. It took BCBS of NC less than one day from the day to approve my surgery. I had everything exactly as they wanted. Be aware you may be required to have medical proof that you were/are morbidly obese for at least four of the last five years. BCBS NC required that proof. No 6 mo. diet, though. Airwayman

BCBS of AL doesn't cover lap-band surgery.

Tami

What about if BCBS of Alabama is a secondary insurance? I have BCBS of NC as a primary, but my secondary is Alabama....

What about if BCBS of Alabama is a secondary insurance? I have BCBS of NC as a primary, but my secondary is Alabama....

All I can tell you with certainty is that BCBS of NC now covers the lap band surgery as of Jan/Feb of '07. My surgery is a week from this coming Monday.

I am so glad for you.....are you in North Carolina? If so, where?

Charlotte....the Queen City

Thanks guys for all the info!!! It helps a lot!

Is it just me...or has everyone at some point been scared sh*tless that their insurance would deny their surgery?!?!

Ok, heres my issue... I have my own "version" of a medically supervised weight loss attempt...the scheduling coordinator/insurance lady-person (not really sure of her official title) was on the phone yesterday with BCBS for my pre auth and was unable to meet with me... I was there dropping off supporting info that they may need to submit for my approval (emails to and from my primary regarding weight loss/exercise/lab requests from 8/06- present and proof of gym membership/payment from 8/05), my primary also sent a letter stating she is aware of my weight loss attempt(s).

I've read Empire BCBS policy on weight loss surgery...and it does not say specifically they need 6 month medically supervised diet (as the coordinator told me)... only "patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for the surgery"

I'm just afraid because I did not participate in a "weight loss program" and did it on my own I will be denied. Am I reading too much into this??

:help:

Melissa, may I ask which BCBS you have?

Empire BC/BS of Delaware

Empire BC/BS of Delaware

Melissa-

I have Empire BCBS of NY. I was told by one coordinator that the 6-months diet was mandatory, but by a second coordinator (two days later) that it was not?! I submitted paperwork that listed 5 months and was approved very quickly (2 days). I had an arsenal of met requirements and left nothing to chance. Document EVERYTHING, fax a copy to your surgeon and keep one for yourself. I think my submittal had over 100 pages of "stuff" including:

PCP letter

personal "mission statement" lol

psych eval/support

cardiologist suport/EKG/Echo

nutritional eval

pulmonolgist support/eval

apnea study/report

endocrinologist report/support letter

dr's visits for over 5 years (including thyroid issues, pregnancy...weight gain & loss)

gym membership receipt

weight watchers "thru the years"

I copied & faxed myself silly. My surgeon's office said it was the quickest approval they've see. I suppose my OCDs pay off sometimes. I'm not certain that all I did was necessary....but it was all well worth it. I'm 16 days post-surgery and feel better than I have in YEARS.

Best of luck to you!

Thank you Jill...

You're list of documentation is a lot like what has been sent to my BCBS. I've been extremely busy this weekend so I really didn't have time to think about the approval.... but of course, I'll call the surgeon's office first thing in the morning!

Is it just me...or has everyone at some point been scared sh*tless that their insurance would deny their surgery?!?!

Ok, heres my issue... I have my own "version" of a medically supervised weight loss attempt...the scheduling coordinator/insurance lady-person (not really sure of her official title) was on the phone yesterday with BCBS for my pre auth and was unable to meet with me... I was there dropping off supporting info that they may need to submit for my approval (emails to and from my primary regarding weight loss/exercise/lab requests from 8/06- present and proof of gym membership/payment from 8/05), my primary also sent a letter stating she is aware of my weight loss attempt(s).

I've read Empire BCBS policy on weight loss surgery...and it does not say specifically they need 6 month medically supervised diet (as the coordinator told me)... only "patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for the surgery"

I'm just afraid because I did not participate in a "weight loss program" and did it on my own I will be denied. Am I reading too much into this??

:help:

Sweet!

Have you...gone to Weight Watchers? Jenny Craig? Have you been on:

The Cabbage Soup Diet

The TWA Stewardess Diet

The Low Carb Diet

The high carb low fat diet

The Canadian hockey team diet?

The wrestlers weigh-in diet

The all fruits and cheese diet

Beets and wheats diet?

My point is these are all attempts at weight loss by other means. I've been on so many diets and diet club memberships I could've paid for my surgery.

I've done:

Phen/Fen...3x

L.A Weightloss

Adkins... 3x

South Beach

Grapefruit

...not to mention the low fat low cal on going diet I've been on and off for the past 20 years....

Not to be negative about the weightloss attempts, but some insurance companies require it to be medically supervised. I was told that unless Atkins was advised and monitored by my doctor it didn't count. I was lucky that I had High Cholestrol and checked in with my doctor every month for a year. I was on a low fat low cholestrol diet and managed to lower my cholestrol by 15 points with just diet. So the proved that I did follow some sort of diet. I also checked in at the office monthly with the NP for weigh-ins and BP checks. ~Mandy

My primary has monitored my BP very closely for the past 8 months or so... and she knows I have followed a diet and exercise routine... I have since dropped my BP from 192/98 to 122/83...with no meds.