OK folks .. I'm trying something and I'll let you how it goes.

I am a benefits/HR person for my company, and it was at the BCBS SC office this past summer that I was at their office for "train the trainer" meetings... it was there that I found out that our SPD ALLOWED for WLS, because I am HR, I am the main contact for my company with BCBS and we were given a special person to be our contact......... anyway... I just sent HER the following email: (btw thanks for posting the billing codes)

Hello Lisa!

Here at the Mother House location, we got our new ID cards in Tuesday’s mail. YEAH!

I have a question for you. In 2007 I’m going to be having a Lap Band put in,

CPT Billing Code: 43770 – Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components).

I’m also enrolled in the CDHP (HRA plan), and utilizing the FSA.

I know that in our SPD we have a provision for it, my question for you is there any special paperwork for OUR PLAN that I will need to complete. I know a couple other employees have approached me already with the same kind of questions, and I want to help THEM as well as myself……….PLEASE HELP.

My surgeon is a Teir 1 provider and the hospital is a Tier 2.

Thanks for all your help!

CROSS YOUR FINGERS FOR ME!!!!!!!!!!!!!!!!! I want to be a bandster EARLY in 2007

I talked with my insurance company today, and lap band, as well as GB, are both covered with the proper documentation.

What is the name of your insurance company?? JB

Its not BC/BS....I just wanted Tracey to know how much I appreciate her knowledge!!

I have Freedom Network~Construction Industry Laborers Fund

Its not BC/BS....I have Freedom Network~Construction Industry Laborers Fund

Rats. I was hoping you covinced BCBS they are being foolish to call this 'investigational.' Good luck!!

From my understanding....once a surgery/procedure had a CPT code, its no longer considered investigational. (lap band's code is CPT 43770) Have you tried this avenue with BC/BS?

I attend my first seminar at Feb 5th at the Bariatric Center of Kansas City!!!

MEW......I will be attending the same seminar. I have been to their seminar back in Nov 05. But since the insurance thing isnt an obstacle now I am ready to get the ball rolling again. They said since it had been so long I had to attend again.

I was hoping there was seminar this week so we could get going. I am hoping for no more snafu's.

Rats. I was hoping you covinced BCBS they are being foolish to call this 'investigational.' Good luck!!

Hello, saw your above note. BC/BS that covers the Auto plant here in Kansas City HAS started covering lapband here. Unless your particular policy has an exclusion I would start the fight.

:clap2: How exciting 2bthinagn!!

Look for me there...I'll be the fat one!! LOL

(sorry, I have a weird sense of humor!!)

I tried to get in to the Feb. 23rd seminar, but they were filled up. The way I see it is...I didnt get fat over night and it wont come off overnight either...so a little wait wont hurt me.

I'm so looking forward to getting this whole process underway! I wish you lots of luck and success in your journey without further setbacks!!

Look for me there...I'll be the fat one!! LOL

(sorry, I have a weird sense of humor!!)

THATS what I was gonna say! You took the words right out of my mouth.

MEW....thats a MONDAY??? Feb 5 right...I thot Monday sounded weird I was thinking they did Tues? I will have to check my calendar.

From my understanding....once a surgery/procedure had a CPT code, its no longer considered investigational. (lap band's code is CPT 43770) Have you tried this avenue with BC/BS?

MEW, I certainly don't want to be branded as 'that negative Airwayman' but I don't want people to get their hopes too high. You are in a different state, things may be different, hopefully. I went to my doctor's Lap Band seminar last night here in Charlotte. He and his office ins. guru said, at the present time, BCBS of North Carolina does NOT cover gastric banding (read Lap Band). My BCBS policy DOES cover WLS but only the R-N-Y or a couple of the other invasive, gut cutting jobbies. It has an exclusion for the Lap Band. Yes, CPT 43770 is the correct code for gastric banding. The doctor even gave us that code last night so we could use it in a fight with BCBS. It, however, doesn't mean they'll pay for it. Providing the correct CPT code to your insurance carrier just insures that everyone is on the same page and is talking about the same procedure. The last thing you'd want is for them to approve your surgery thinking it was one of the approved types of WLS, and once you have it, they realize it was for the Lap Band and they don't cover it. The unofficial word around here is BCBS has paid for a few gastric bandings lately but only after you burn through a couple of your appeals. I have no proof of this...just a rumor. I am going to self pay, here's why: My doctor said he can do the surgery in the two name brand hospitals in Charlotte if the patient was going the insurance route but, starting next month, he can do them at an outpatient surgical center (my wife got her boobie job there...its a nice clean place). No overnight stay, and more importantly, a huge discount. The hospitals vary from 19,000+ to 23,000+ for Lap Band surgery. The cost of doing it in the outpatient clinic, plus one year of fills, office visits with my Dr. is $14,900. Tax, Title, license. The reason for the dramatic difference in cost is that when you use the outpatient clinic it's self pay only. The doctor and the clinic are giving a 25% discount if they don't have to screw with the ins. companies.

I dont think you're being negative at all Airwayman....just cautious, and thats not always a bad thing! I'm new to this whole process and I'm doing my best to learn all I can, and I certainly dont have all the answers, I was just stating what I "thought" I learned....guess I'll need to check into that even more.

My husband and I had long talks about what would happen if our insurance wouldnt pay for the band, and the idea of self-pay came up quite often, although it would be a long time before we would have been able to do it, but we would have found a way. The price you have quoted sounds very reasonable!! I may have to get back to you and find out more about this place if, God forbid, my insurance finds some reason for a denial!!

Sounds like you have found a great place to have your procedure done, and I wish you much success!!

2bthinagn....I was almost in a panic!! I had to run and get my calendar to make sure the 5th was on Monday like they told me...thought maybe they had made a mistake...but nope!! Monday, Feb 5th it is!!!

I got my "official" paper invite in the mail today, too!!

My little guy is home from school sick and so I'm on momma time today... I decided to check my work email and loooooook at what was waiting for me! I AM SOOOOOOOOOOOO HAPPPPPPPPPPPPPPPPY!

Hello Tracy,

Good News, BCBS has approved you for the procedure and a letter is on its way. So Congratulations!!!!!! As far as scheduling you for surgery, we have to have the approval letter in hand before scheduling. Allow at least one week for us to get this letter. They just called me today regarding the approval so that usually means the letter will go out today or the next couple days. Once we receive the letter, Nikki will call you to schedule. FYI: We are getting overwhelmed with approvals right now and Nikki schedules surgeries in the order she receives the approval letters ( to be fair ), so it may take her a couple days after receiving the letter to call you and there may be a wait on surgery. I know we had talked about this before, but I’m just letting all of my patients with approvals know the situation. Congratulations!!!

Rachel

OMG Tracey!! That's terrific news!!! I'm so happy for you...your stamina and determination has really paid off!!!

I was checking through the posts earlier today, hoping to see something like this!!!

Congratulations!!!

(BTW...I am also in KS...Kansas City!)

THANKS MEW! (oh and if I had to go self pay I'd hop a quick flight to Denver and go with www.lapbandrockies.com ) under 10K... and all your consults are done over the phone... check out the Dr. K thread....GOOD LUCK with the insurance route though, and keep us posted!