:help:Hi all

I have fderal bc/bs and am trying diligently to get them to pre approve my lap band surgery. They keep telling me to have the surgery and then they will review it for medical necessity. Has anyone else had luck getting them to pre approve this? My surgeon will not do the surgery without it, which I can understand that he can't take the risk of not getting paid. Pleas help me if you have had experience with this, as I am at my wits end.

I have BCBS Federal Basic. I called to ask if they covered the lapband and the fills. I got the codes from my surgeon's office before I called.

BCBS Federal said they could not tell me 100% on the phone that they would approve it, but if I was 100 lbs or more overweight with a BMI over 40, or if I was substantially overweight with one or more co morbidities, then it was likely they would pay for it. Also, BCBS Federal did not require the 6 month supervised diet or psych eval. The person told me to work through my surgeon's office. My surgeon's office gives everyone a packet, they want statements from all of your doctor's to support that your weight is causing you an issue.

My PCP wrote a letter, my cardiologist (I don't have a heart problem but there is VERY strong heredity issues and my weight makes me a target), I was pre-diabetic, pre-hypertensive, and just starting to get high cholesterol, mild sleep apnea, back problems and just starting to get foot and knee problems. I went to each of these doctors throughout the past year to be evaluated. They all wrote letters and faxed them to my surgeon ASAP. My surgeon's office submitted and within 4 days I received approval. I was freaked, I thought it would take so much time.

I owed the surgeon $100, and the hospital $100.

Good luck...