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

Thanks Tracey....I saved the link, just in case but I hope I never have to use it...LOL

I've read lots of good things about Dr. Malley (unfortunately, he's not in my network), and I wish you as much success in the next step of your journey as you have had in your insurance battle!!

I dont even know you and I'm tickled pink for you!! *giggle* Cant wait until my hubby gets home and I tell him that you are approved...we have both been following your story!! I'll be anxiously waiting to "hear" your surgery date!!!

First I was extremely HAPPY because they have my approval.... all set..

then guess what I found an ERROR.. a typo... look at the authorization period..... uhhhhhhh... duhhh..... 12/31/2007??

So I have emailed my bcbs sc, contact and asked them to FIX the typo ASAP! Last thing I need is a typo holding me up!

(THIS IS WHY.. I'm a HUGE proponent of employees logging IN to their insurance websites) Better to be PRO-Active rather than RE-Active!

Here is the information about the entry you chose:

Authorization Number: 07xxxxxxxxxxx2

Authorization Status: APPROVED

Authorization Period: 12/31/2007 to 01/01/2008

Rendering Provider: MENORAH MEDICAL CENTER

Service Location: INPATIENT HOSPITAL

Facility: MENORAH MEDICAL CENTER

Days: 001

Authorization Status: APPROVED

Authorization Period: 01/10/2007 to 01/10/2007

Rendering Provider: YOUR PROVIDER

Service Location: INPATIENT HOSPITAL

Service: 43770 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTI

Units: 001

Wow Tracey...its so good that you caught that typo when you did!! You're always right on top of everything!!

I noticed that your authorization date a little lower down is for 1/10/07 to 1/10/07....can I ask why that is?

Thanks Mew....... I don't know what the 1/10/2007 is about... the only think I can come up with is the 10th is the date my surgeons office FIRST called them to see if they indeed did cover it AND found out what the requirements were for approval. (That's the day I found out I had to do a psych and nutrition eval)

First I was extremely HAPPY because they have my approval.... all set..

then guess what I found an ERROR.. a typo... look at the authorization period..... uhhhhhhh... duhhh..... 12/31/2007??

So I have emailed my bcbs sc, contact and asked them to FIX the typo ASAP! Last thing I need is a typo holding me up!

(THIS IS WHY.. I'm a HUGE proponent of employees logging IN to their insurance websites) Better to be PRO-Active rather than RE-Active!

Here is the information about the entry you chose:

Authorization Number: 07xxxxxxxxxxx2

Authorization Status: APPROVED

Authorization Period: 12/31/2007 to 01/01/2008

Rendering Provider: MENORAH MEDICAL CENTER

Service Location: INPATIENT HOSPITAL

Facility: MENORAH MEDICAL CENTER

Days: 001

Authorization Status: APPROVED

Authorization Period: 01/10/2007 to 01/10/2007

Rendering Provider: YOUR PROVIDER

Service Location: INPATIENT HOSPITAL

Service: 43770 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTI

Units: 001

Woo Hoo I agree 100%!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Tracy they'll fix that in a snap. Just a typo.

Just got this from my contact....

Tracy, I sent this over to my manager after we talked this morning

for him to forward to the correct person in the HRA department. Thank you for bringing this to our attention and we will get it to the correct person so they can resolve it for you. Hope you have a great day.

Stephanie

Oh and I might add that she said they will most likely do an audit on everyone just to make sure there isn't a glitch in the system

Just got this from my contact....

Tracy, I sent this over to my manager after we talked this morning

for him to forward to the correct person in the HRA department. Thank you for bringing this to our attention and we will get it to the correct person so they can resolve it for you. Hope you have a great day.

Stephanie

Oh and I might add that she said they will most likely do an audit on everyone just to make sure there isn't a glitch in the system

You did them a favor! Great news Tracy. I'm so happy. Maybe we are going to have our surgeries in the same month. That would be amazing!

I am STILL waiting on the approval letter to hit my mailbox and the mailbox of the doctors office, but I did call the 800 number today and asked them about it.. they said it was sent both to the member (me) and the provider (surgeon) on 1/29/07. They also said that the date was just something they put in to get it going.. (dummy date) and that it is done all the time.. just not noticed by the member (me) She said it shouldn't hold anything up........

That was all my news for today...

If it doesn't get there today, it will be there on Monday! Way to go.

LD: YOU WERE SOOOOOO RIGHT!

It's Monday, and I went home at lunch to check my mail box, and the approval letter WAS THERE!

However, I'm a little concerned.... they do list the 12/31/2007 date, and they DID NOT send a copy to my doctor, instead they sent it to the HOSPITAL. I called my surgeon and they told me to fax it over...... I did

We shall see.............. maybe if I hold my teeth just right I will get a call today! :biggrin1:

Thanks to everyone who is out there in cyber land rooting me on!

:update: APRIL 26th, 2007

I guess BCBS has been approving LapBands like wild fire and since they (dr's affiliation) only have ONE center that accepts them (Menorah) I am bumped all the way to the end of April.

I am a bit depressed about the long wait, but am happy to at least HAVE a date and I was put on the cancellation call list.

:typing: Now I'm off to update my RL people who know.

:update: APRIL 26th, 2007

I guess BCBS has been approving LapBands like wild fire and since they (dr's affiliation) only have ONE center that accepts them (Menorah) I am bumped all the way to the end of April.

I am a bit depressed about the long wait, but am happy to at least HAVE a date and I was put on the cancellation call list.

:typing: Now I'm off to update my RL people who know.

:clap2: :clap2: I knew it! And I suspected the other would potentially happen. I can forsee when there will be a six month waiting list.

When I had my meeting, the rep from BCBS said that he felt in the near future BCBS would have a change of policy. (so many successes, it's inevitable).

Tracy, a big cyber hug to you my friend. Way to go. April is just around the corner.

Thanks LD!!!!!!!!!!! Yours is next!

I've started a new thread that I will be posting updates on:

http://www.lapbandtalk.com/april-2007-head-t29472.html