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???

Hey -

I guess enough of us have beaten them about the head and shoulders to get them to change their guidlines, Huh?

:]

It's great that more and more companies are covering it. Seems a huge waste of money for them to deny it when they know they will lose in appeals. I guess they figure that making you appeal also weeds out those that are not serious??? ~Mandy

Im under my dads insurance since im a student and he has BCBS of Michigan even though we live in Ohio. My BMI is 38-ish. With bad joints and a bad back, plus high blood pressure. Do you think im in for a fight? or do you guys think it might be covered?

Depends on the policy, sounds like you definatly qualify for the band. Do you have 6 months of medically supervised weightloss programs? Does the policy cover WLS? If so do they cover the band? Ask the surgeon that you are considering what CPT code they use and then call and ask the insurance company. Good luck, Mandy

piercedqt78: I haven't done a medically supervised program. I've done upwards of 20 different diets and the most i've ever lost on them was around 30 pounds but gained it back and then some (as most everyone does). Is the fact i've never dont the medically supervised ones going to be an issue? Sorry If im bugging you but all i've found in all my research is about the procedure and success stories. My best friend keeps telling me i shouldn't have a problem because i have a heart condition (not cause by weight... but it doesnt help matters) and my BMI is really close to 40.

I saw your myspace and really like your tattoos... btw. and thanks for your help.

Thanks about the tattoos, I love them. It depends on the policy, some require 6 months of medically supervised weightloss attempts some don't. I would call the prospective surgeon and ask about their billing codes, then call the insurance company and ask about the policy regarding banding. You will need the codes that they bill with, or they will give you generic information that might be incorrect. I was told the weightloss surgery was covered with a certain set of guidlines, then when I submitted for preapproval I was told that the band was excluded due to it being exerimental. I fought that and won. Make sure you note each and every call that is made to the insurance and the employer, write down the date, time and persons name. This can be a huge help, if you need any help or have any questions please let me know. ~Mandy

I love tattoos too. I have two of thm so far and will get a ton more if i can get banded and lose weight.

Thank you soooooo much. Im so lost about this whole insurance thing and you just saved my ass since my dad is scatter brained and my mom knows less than me.

I have BCBS of Mass. and they seem very receptive to the lap-band surgery. When I called to ask, the faxed me their policy with their specific guidelines, i.e. BMI's, evidence of failed weight control programs, past nutritional counseling, co-morbidities. I meet all their requirements and we just applied. My doctor's insurance person thought we shouldn't have any problems.

xlil misfitx--you have received really good advice, my only addition would be to get started!!! Make an appointment to begin a 6 month program, and if you find out you don't need it, you can skip it, but if you do, you will have some of that time already behind you!!! Plus it opens the communication about you wanting the surgery with your PCP, which is necessary! Good Luck!!!

Kat

Where can I get a copy of the 2007 Benefit Book? What state are you in?

Lap-Banding WILL be covered by BCBS in 2007. Per changes in the 2007 Benifit Book.

Call the number on the back of your card and request a benefit book, or contact HR and ask for the latest copy. ~Mandy

I was turned down twice by Blue Cross and have finally been approved. It has taken some time. I worked through the AIGB in Dallas to get it approved. My surgery date is December 21.

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???

SHYTXROSE

I'm in Dallas. You said that you were declined by bcbs twice--how long was that process???????????????

I was denied 3 times by BCBS in 6 months. ~Mandy

I need to get out my calendars to be sure about the timeline. I think I have been working on it almost 2 years. I was really disappointed last spring when I thought I had done all my documentation. I went to Weight Watchers for 7 months thinking it would help me document and learn stuff too but it didn't help. What really helped was going through AIGB for weight checks. They did the application for me this time. Also, they called me when they heard the documentation of monthly weight checks needed to be 6 months instead of a year. It helped having them on my side.

Now it is up to me. The hard part. Doing without my favorite drug - food.