Hello

Does anyone have BCBSAZ PPO insurance? If so, do they cover weight loss surgery?

Thank you

Did you ever get an answer? I am in AZ and looking at lapband? did they cover?

Did you ever get an answer? I am in AZ and looking at lapband? did they cover?

Yes...they cover...it is going to be a challenge to try to get BCBS to pay for the lapband. So, Ihave made a decision to try to self pay. Here is the policy:

SURGERY FOR MORBID OBESITY (cont.)

Criteria: (cont.)

A. Bariatric Surgery: (cont.)

Bariatric surgery is considered medically necessary with documentation of ALL of the following:

(cont.)

3. Diagnosis of morbid obesity for the past consecutive 5 years

4. Failure of non-surgical methods of weight loss with documentation of the following:

▪ Continuous participation in a weight loss program for 6 months or longer within the past 12

months. Weight loss program includes:

- A structured program that includes documentation of diet and dates of participation (a

minimum of one face-to-face visit per week attendance for dietary counseling/education

is required), and,

- A structured exercise program (unless medically contraindicated) designed and

supervised by a certified or qualified professional with documentation of attendance (a

minimum of three sessions per week of participation in an exercise program is required),

and,

- Demonstration of a commitment to results by documenting weight loss, maintenance, or

no more than a 5 pound weight gain over a minimum six month period

5. Pre-operative clinical assessment and documentation must reflect a significant motivation and

understanding of the risks associated with the intended surgery, as well as an understanding of

the life-long restricted eating habits that will follow.

6. Clinical documentation must reflect a plan for active participation in both a pre-surgical

instructional program AND a post-surgical, post-operative or follow-up program. Clinical

documentation must reflect participation in pre-operative nutritional counseling and that there is a

plan in place for post-operative nutritional counseling as well.

7. Individual is 18 years of age or older

8. Individual has no treatable condition that may be responsible for the morbid obesity, e.g.,

endocrine, metabolic, etc.

9. Individual has no significant liver, kidney or gastrointestinal disease

10. Individual has no drug or alcohol abuse – must be abstinent for 12 months or more if there is a

history of drug or alcohol abuse

I have most of it, except for the enrollment of a exercise program. I am unable to afford the gym card along with the 1000.00 access fee.

And your first born too, right?

That criteria is ridiculous. Like someone said before I think some plans make it hard so it will discourage us and we will decide not to do it.

I know.....it is a shame.....so I may have to go in debt just to get the lapband. I am still trying to make a decision on what to do right now. It is so depressing to think about it.

Wow! That is absurd!!! I would at least submit what you have and then appeal based on their obviously ridiculous requirements, at least you tried.

I am going to make an appointment to see Dr. Simpson I was told that they have not had anyone been approved by BCBS. I will give it a try and if all fails then I will have to finance it. Thanks for the advice!

Those are pretty typical requirements, you may want to look into Curves, they don't have a very high sign up and it's a low monthly payment. In order to be successful with the band exercise really is needed

i live in ny and am banded. i have blue cross blue shield pos and had no problem. just had to meet with a dietitian once a month for 6 months. my girlfriend has ppo and she didnt even have to do the six month diet. just being overweight was all she needed to get approved.

I wish I could do Curves...but gyms are not for me. I have been walking and using workout tapes. I've tried the gym thing, but all I ever did was waste my membership card. I am more the outdoorsy type. Once I can build some confidence in going to a gym, then I will think about it.

It really has a lot to do with what plan your employer decides on. I wish it was that easy for me. Does she have the BCBS of Arizona?