Discouraged

January 3, 2005

My husband has been looking into the lap band procedure and has been waiting for about 1 year now and still has not been scheduled. The sad part is that my health insurance changed as of January 1st and now we have Blue Cross Blue Shield of TN. I have heard that BCBS does not pay for this surgery. Does anyone know for sure?

whippledaddy · January 3, 2005

BCBS is different in every state, and nearly every employer. In Michigan they pay for it, but in other states they do not. I called them and asked if they pay for it based on the proper diagnosis code and procedure code. Try that.

leatha_g · January 3, 2005

Each employer will definitely be different. It is the employer that chooses what exclusions and inclusions are allowed, not the insurance company. BCBS may or may not offer these options also, as you said, each state seems to be different with them. Good luck!

Alexandra · January 3, 2005

Each employer will definitely be different. It is the employer that chooses what exclusions and inclusions are allowed, not the insurance company. BCBS may or may not offer these options also, as you said, each state seems to be different with them. Good luck!

This isn't always the case, actually. Large businesses may be able to write their own contracts with insurance carriers, but in NJ at least and possibly in others, small to mid-size businesses must buy standard contracts. Also, in many states there are mandated levels of coverage that override even standard contracts. (So, for example, a carrier may try to exclude something that is forbidden for them to exclude by law in that state.)

It takes a lot of research. Start by checking with your employer to find out what kind of plan you have and where the bottom line authority is on contract provisions. One state's rules are not like the next one's, so asking here for advice will only get you so far.