I am waiting for the doctors office to call me back with the reason for the denial. I called to check the status and the insurance compny said a letter was faxed to the office and one was mailed to me today and could take up to 2 weeks to arrive. I called the office and the co-ordinator is going to get my fax and call me back.... This stinks...~Mandy

Mandy,

Just a quick followup on my previous post. I would suggest that you take a look at some of the old Posts for the Yahoo Group named "BandstersInsurance". A post made by April 28th contains a link to a PDF file. The person that posted it contacted the FDA and received a person letter indicating that the LapBand was not experimental. Maybe you could contact the cooperative person at the FDA and have her send you the same type of letter. Her name was Bonnie J Alderton and here is a link to the cover letter that she provided:

http://groups.yahoo.com/group/BandstersInsurance/files/FDA%20Letter.pdf

Please note that I think you have to be a member of the Group to get the Link to work, but they add members pretty quickly. I found other posts on this Group list most helpful. Hang in there - Things WILL get better!

I heard that BCBS as of May 1, 2005, is now paying for people to be banded.

Lea

I heard that BCBS as of May 1, 2005, is now paying for people to be banded.

Lea

Just want to clarify and be sure everyone knows that what's true for one state's BCBS is not going to apply for others. They are all separate companies, and the rules are NOT universal.

What I've heard is that BCBS of California and Texas have just decided to cover banding, which is a HUGE step in the right direction. But it doesn't mean they all will.

Is there a list of all of the bcbs companies that cover the band? I also know that every company sets its own limits for what it will cover. ~Mandy

Mandy,

The Yahoo Group BandstersInsurance has a database with Insurance information. It currently contains 357 lines of data including names of Insurance companies. states, approved or not, appeals, Doctors, etc.

Can't tell how 'complete' the information is, but it does represent other people's experiences with their respective insurance companies.

Good Luck!

Just to offer some clarification on the entire issue of insurance in general on this issue - ( I happen to work for a carrier)

1) If you work for a large employer - chances are your group is what is called self-funded, this means that your company is actually paying the claims, not the insurance carrier. The insurance carrier is just administering the claim. The employer will actually set the rules around what is and what is not covered. The company will also approve the process that the carrier uses to determine elligiblity for this type of procedure. Only in some states are their state mandated benefits. Thus, you can have two people with the exact same situation, both with the same insurance carrier's name on their card with very different situations. (I know for a fact that Union Pacific is self-funded)

2) BCBS is mentioned a number of times - All BCBS companies are not the same, they all carry the BCBS logo, which only means that they are a part of BCBS Association. BCBS of Illinios owns the BCBS in TX and NM. Empire is a seperate BCBS of its own. Wellpoint owns BCBS in Colorado, California, MO, and 10 other states (previously known also as Anthem BCBS).

3) So- if the company that you work for, or the fully-insured policy that you have approves the surgery, then it will go to the medical review. They will often deny the claim in the first go around, but it would definetely be worth appealing in all situations. Most of the time the first refusal is automatic and NOT a decision made by an individual, but a computer that is looking at a number of different factors. Once appealed, most companies send it to a medical review board where individuals actually evaluate and make a decision about the claim.

All companies and policies are different, take the time to put some research into it!

Hope this helps to understand the insurance side a little better.