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 there! I know I've emailed you before about NCBCBS. I'm in Charlotte too, been working on all my Pre-op torture and have my consult with the Surgeon tomorrow. So hopefully everything will get rolling! Any tips on getting approved? I was wondering who did your surgery and how you were doing as well. Any info would be helpful. I can't wait to submit everything. I'm so excited about it all. Thanks! WW

Hi, I also have BCBS Fed and I did not have to go through anything. My Dr's office said that the only requirements that BCBS Federal has is that your BMI be over 40. Which mine was (is). My request was sent on a Friday, and the office called on the next Wednesday with an approval. I started all of my process at the end of March and my surgery is scheduled for May 10th.

So, today was the big day! Can't wait to hear how it all went!

I have Federal BCBS also...just waiting for my insurance approval!

My surgery has been scheduled for May 25, 2007. However, I have agreed to self pay up front and they will file a claim with my insurance after the surgery. I have Fed BCBS.

Madine

My surgery has been scheduled for May 25, 2007. However, I have agreed to self pay up front and they will file a claim with my insurance after the surgery. I have Fed BCBS.

Madine

I don't understand why you have to self pay up front? My insurance approval came in only a few days and I have Fed BCBS...?

Because Fed BCBS of Texas does not pre approve for any procedure. You must file a claim after the surgery for approval. My doctor has not had any prior experience with Fed BCBS and is concerned whether they will pay.

Madine

Because Fed BCBS of Texas does not pre approve for any procedure. You must file a claim after the surgery for approval. My doctor has not had any prior experience with Fed BCBS and is concerned whether they will pay.

Madine

BCBS Fed told me that too but then sent me an approval letter that is IDENTICAL to the one my DH got for back surgery.

BCBS Fed told me that too but then sent me an approval letter that is IDENTICAL to the one my DH got for back surgery.

I have good news. My doctor's office called me today and said that I did not have to prepay that they would file a claim with BSCS Fed after the surgery. My surgery is scheduled for May 31 now instead of May 25th. I wonder what happen to change their opinion?

Madine

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???

BCBS of NC approved lap band WLS in late January of '07. They just paid my hospital bill but denied the doctor's bill. I'll wait on the sidelines and see what happens. I'm sure it was just a technicality.

Beachgirl,

I know what you mean, I am single,60 yrs old and pay 300.00 a month for Regency Blueshiled. With diabetes, arthritis, FMS, Gallbladder disease and other things, I thought it would be a shoe in. When they announced that as of Jan. of this year they would pay for the Lapband, I was really excited after 2 years of looking and working on this. But! my company has an (exclusion) # 27 that will not pay for any thing dealing with weight loss. I have even had to have my family doctor make sure to put it in my notes but to not mention any weight loss on my visits or they will not pay for office calls. Makes me wonder why I have the insurance. But, after 2 years, I am not giving up!

I found this link. You may find it helpful: Surgery for Morbid Obesity

Hello, everyone! I am scheduled for surgery july 2nd. Just called the surgeon's office to see if I had been approved for the surgery by my BCBS of Western NY and the secretary said she hadn't sent it in yet!!! OMG! I asked her how long it took for approval and she said "3 days". I'm really anxious now. What if I'm denied and there is no time for a counter/claim, etc? The secretary said she would send it in tomorrow. Im not sure I trust her! Sigh!

I've been battling to get bcbc FEP to pay for the pre-diagnostic stuff for quite a few months. Now they are starting to pay. For a long time they would say "yes, you're covered", then not pay. I still have two outstanding bills that I'm waiting for them to pay.

Also, my file was not sent to the surgeon like I thought it would be and a month later I found out it was still with the clinic, "oops we forgot to forward it". They finally scheduled me to see the surgeon in July. This has been going on since February. It seems like others go through much faster than I but I guess I'm ok with it. By the time I have surgery it'll be August or maybe even September. But...I guess thats ok.

Keeping positive about it now.:bored

BCBS Fed told me that too but then sent me an approval letter that is IDENTICAL to the one my DH got for back surgery.

Ragdollx19, how are you doing since your surgery? I had mine May 31th. I will see my doctor Monday 18th for a follow up. I became very tired of liquid protein drinks after about a week. I have been eating baked potatoes and grilled fish with no problems. The only indication I have of too much food is hiccups. However, I would like to hear how you are doing.

I have not heard any news about payment from BCBS Fep, yet. Of course, it has only been two weeks tomorrow.

Madine

246 on surgery day, down to 230 today.

Hi, I have Horizon BC/BS of NJ and had my first fill end of April and just got a statement from saying that I'm responsible and not covered. The cost is $900...those of you who have BC/BS is yr insurance paying for the fills or are you?

Hi, I have Horizon BC/BS of NJ and had my first fill end of April and just got a statement from saying that I'm responsible and not covered. The cost is $900...those of you who have BC/BS is yr insurance paying for the fills or are you?

I'm not banded yet (FRIDAY!!) but my understanding is that I will be covered for fills. Of course, all policies are different... I have federal BCBS and there are advantages there.

Either way, a $900 charge for a fill is INSANE!!! Around these boards I've seen them for anywhere from $100 - $250... you may ask your doc, he may have a reduced fill rate for self pay patients.

Good luck!!

I was all teed up to have my surgery in January only to learn at the last minute that it was not covered by my BCBS of NC. So, I had to cancel the surgery at the last minute and go through the appeals process. I'm happy to report that the appeal worked and I have since had the surgery-- just 4 months later. It was a big disappointment at the time, but, it all worked out. If you have to appeal, contact obesitylaw.com. They handled my appeal free-of-charge. It took them a little while--maybe a month or so, but, it was free.