My hopefully-soon-to-be band doctor suggested I switch insurance companies since I have blue cross blue shield and they don't cover it. can you guys tell me what insurance you have and how easy/hard it was to get it covered and what the pre-reqs were. thanks

Hi Lovecats,

Thats really a tough question to answer. There are tons of insurance companies that pay for AGB (Adjustable Gastric Banding - lapband). I recommend that you get a copy of the different insurance companies that your work carries, and start from there. You can get phone numbers for each one and simply call and ask them IF they pay for this surgery! Thats where I would start.

The requirements vary from one company to another. Some ask for documented weightloss attempts from a physician for at least 6 months prior to WLS (weight loss surgery)... some Ins. companies require you to have a physic. evaluation, some require a consultation with a dietian - some want you to get both. Each one has their own rules.

Once you find the "right" Insurance company, they should be able to answer that question.

Good luck.

(I had Mail Handlers Benefit Plan Insurance company)

I have BC/BS of Illinois and they cover it. I also work for Great West Healthcare and we approve them all the time.

Lovecats, I'm guessing you don't live in NJ. Every state is different, in fact lots of Blue Cross companies DO cover banding.

You'll have to give more information about where you live before anyone can give you helpful advice. And even then, a lot will depend on the particular plan you have; one carrier can have many, many different plans.

I have bluecross/blueshield of NJ and they cover everything

I also have BC/BS (of Mass) and they covered my surgery 100%...

I have United Healthcare and I was approved...in NC

I am still waiting for my approval, but I have Empire BCBS and live in Fl, but it is a covered procedure on my policy.

This link was very informative about several different kinds of insurance and what the requirements were for each. Hope it helps! http://www.stvincents.org/healthservices/bariatrics/informationinsurance.cfm

I have BCBS of LA I wonder if they will pay for my fills since I self paid my surgery, does anyone know?

It isn't only the different agencies but what specific plan your company has. If the company can add clauses to the insurance. For instance, I have United Healthcare which covers most people's band 100% but the company my husband works for (which is self-insured through UHC) has a clause that they only allow 50% coverage for any obisity related surgury and there is a clause that it has to be at an outpatient facility and yada yada yada.

So it probably wouldn't be of much help to know what agency covered other's bands because it will depend on the actual policy.

I posted this a while back, trying to offer some clarification on the insurance issue. The important thing to remember is that the POLICY dictates whether it is covered or not, NOT the carrier. The carrier may help make a determination of medical neccessity and whether or not the band is an approved method or not, but the POLICY HOLDER (IE your company) detremines what is covered in the policy. Private or individual policies gernerally will not cover this procedure.

Clarification on Insurance

<HR style="COLOR: #d1d1e1" SIZE=1><!-- / icon and title --><!-- message -->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.

Hi! I found this info on a Dallas area bariatric surgery website: http://www.bscdallas.com/insurance.html

Perhaps it will help, but like Soonergirl says, it all depends on the policy...

Good luck! Cindy

thanks SO much for the info - you guys are the best!

I have BC/BS of Illinois and they cover it. I also work for Great West Healthcare and we approve them all the time.

how much does great west cover? will i just have to meet my deductable?

Here's what I did. I started at my current employer in June. When it came time to pick my carrier, I "circled" those that I knew had covered some type of WLS procedure before. Then I asked to see their SPDs, and read each one to see who had WLS exclusions and who did not. This brought me down to 4 choices. Of these 4, I went with the one that had covered the most WLS procedures in my geographic area. It just so happened to be the same carrier I had at my previous company, and I love 'em.

Once I knew which carrier I was going to have, I talked with my employer's HR area to ask if they had any policy exclusions, as mentioned above. They told me that they offered the po;icy at face-value, ala did not deny anything the policy included.

After I was approved (apparently w/ no requirements other than high BMI) I called my HR area again, and told them I had received a letter of pre-approval, but the letter said that my coverage "may or may not" cover the WLS. I asked them if my coverage would or not. Their reply was that the letter must have been a form letter, because they do not dis-allow anything that the SPD allows for.

BTW, here's word on the street, so to speak. I've heard this both from a good friend who is a doctor, and from my personal doctor. Insurance companies got a lot tigheter about WLS this year, and are expected to get even tighter before the year is over. Why? They're realizing that it does not make financial sense for them to cover the cost of the procedure. Yes, it is cheaper than medications & treatments for comorbs in the long run, but "in the long run" is the key phrase, and the average subscriber does not stay with the same company for "the long run". Too many people changing jobs, changing providers, etc.

I didn't have any problems with my coverage. In fact, I didn't have to submit a diet history or have one single test outside of my physical. I don't have significant comorbs. My blood levels are in check. Blood pressure is spot on. No diabetes. No hypertension, etc. My company still pre-approved me within a week.

BTW - do check with your employer. My employer is within the top 35 of the Fortune 500, employees who knows how many people, and did not exclude anything from the carrier's policy.

Doh, I forgot! I have UHC EPO.