Blue Cross HMO anyone hear of this?

[Guest carol conlogue]

I just received a note (by my request) from BCBS Federal saying they do not pay for lap band surgery, period. I was stone-walled for 2 months trying to get a straight answer. My surgeon has put through claims for this benefit and never has won, not even on appeal. So, they have been accepting applications all the time knowing....even letting people appeal....full well they never had it for a benefit.

Like you, I am not giving up!

[Heycomputergirl 0]

:heh: Greg

My spouse also is retired law enforcement with Blue Cross. I am researching having the procedure myself. Was interested inknowing if your Blue Cross is with California. Thanks

When I retired from the police department I was given the reitrees insurance which is traditional Blue Cross and Blue Shield. When I was working I had Blue Cross PPO.

When I called about the surgery they told me it was covered as long as I meet the requirements which in my case was no problem. Once I got all the paperwork it was approved very quickly. B/C & B/S have paid everything except a few minor costs covering the excersice program and follow up with a nutritionalist. But so far my out of pocket hasn't been over $200.00. And I'd pay lot more then this if I had to.

The cost of our surgery is set up that all visits no matter how many are covered for one year from date of surgery. After that my insuracne will cover visits and fills. Also they have already told me that after one year of being banded they will cover the plastic surgery for removal of an apron if one exsist. All they need is a letter from my dr stating that this surgery is necessary for health reasons.

Sionce I picked up on my exercising my weight loss has slowed almost to a stand still but my body is making adjustments that I like, (lossing inches and flab areas are firming uo). Even my apron isn't falling like I expected it too and it appears if I stay on track I may be able to forgo that surgery. I'd love to have it now as it would probably be an instant 25-30 pond loss. But I'll be happy to try the hard way first.

My problem is that the Police Department where I used to work is being offered a very good contract. One of the conditions is they have to except a change in retirees insurance to Comm Blue I from B/C & B/S. Unfortunatley I don't have a say in this. I understand that the officers are against the city touching anything the retirees have and have opposed this so far. I fear the city will offer them more salary now as the change in the insuracne will save them lots of money down the road. If they chage to the new plan for me I'm not sure what will be covered. Except I do know they have to honor what they have covered up to now.

The city that I work for now gives me $2,000.00+ cash every Dec NOT to take the insurance they offer other ful time employees. Cost them about $7,000.00 a year to have me on the insurance so I understand giving paying me not to take it is sound business.

The insurance in this country is in serious need of overhauling.

[piercedqt78 658]

Don't give up fighting the insurance. I was denied 3 times and was told that a snowball had a better chance in hell then I did to be covered. I was told that I could be approved for GBP that day if I wanted but the band was considered experimental and simply was not covered. I was covered 100% and so far my fills have also been covered 100%. You have to keep fighting and be prepared to take it to a state insurance review board. It is possible to win, I know I did. ~Mandy

[TheWatcher 1]

Ok so i have Blue Cross of California HMO

im 24 and i have been hearing a lot of stories that Blue Cross hasn't been making this process hard. I am a person that always hope for the best and expects the wost so it makes me a little nervous when i find out that i may be able to get this Tool to help me change my life with little or no red tape.

If anyone has advice that might be able to help me please let me know.

i live in the SF Bay Area so if anyone knows anything once again help a brotha out.:ranger::help:

[QTkidsmom 0]

Different state but I am insured by BC of California (California Care HMO) and my surgery, visits and fills have all been covered at just my copay. Don't lose hope, get the auth and you should be fine. I actually work in Managed Care, I am a manager for an HMO to be exact. If they try to deny after the rep said it was covered, appeal it and be sure to quote the day/time of the call and name of rep in your appeal.

[Skinnyagain 12]

why did you have your band removed???

[cyndilou29 0]

I have BCBS of NJ where it is excluded but they've paid a lot of it so far. They paid for all pre-op visits (except 1 dietician visit for $116, go figure) and post-op too. They paid for everything except the anesthesia thus far regarding my surgery. They paid the surgical suite and my hospital room but apparently they wanted me to do it wide awake. Still waiting on surgeon's fee (should be $5500) I'm sure they won't cover that either. However, I was prepared to spend $18000 and I'll be paying about $7000. BIG difference!

[Lap_dancer 8]

Mrs. P, I wouldn't get so excited yet. The person on the phone probably has no idea that there is no CPT code yet specifically for fills, and has probably never heard of the lapband. I'm not saying it's impossible, but just that you should never take anything you hear from a customer service rep as gospel.

When you get a fill there are a couple of elements to the claim, like the doctor visit plus the procedure itself. Your HMO might, for example, pay for the visit and exclude the procedure because it's not "medically necessary." But whatever they pay for is better than nothing!! Good luck!!

Yes, I have BCBS of FL and they do not cover anything related to weightloss surgery/Lap Band.

Not to burst your bubble but call them back and ask for the name of a doctor in your area that does aftercare who is " in network ".