Hi I have had a HMO for the past two years and have tried to get referred for the Lap Band three times and have been denied every time. I just finally filled out the paperwork at work to switch to the PPO. My doctor said as soon as I get my PPO finalized, that I can call her and she will will write me a prescription for the Lap Band.

Now that seems so easy. I have had almost a year of discouragement with trying to get the Lap Band. Does anyone know what my process should be once I get the PPO? Anyone know of any doctors in Ventura County or San Fernando Valley?

Thanks!

I also have BC/BS Anthem PPO. But I am in Washington. I just completed everything and everything is being sent into the insurance tomorrow. I am hoping there is nothing else needed. I am also wondering how long it will take for them to send an approval. I will let you know. Did they say how long it will take to switch you over to PPO?

Hi... how did you find a preferred surgeon? My work said my PPO was effective as of November 1st but Blue Cross said it still hasn't been processed yet. I am so nervous because with my HMO I got denied THREE times and they kept telling me switch to a PPO... but now I am just sure something will go wrong. My insurance says that I have to pay 20% of everything up to $3000. After that they will pay everything at 100%. So I am planning on financing it at this point. I am 26 and am ready to put on a skirt for once. Let me know how it goes... what was your process?

Hang in there. You can go to Anthem.com and log in as a guest to view doctors. They did not have a section for lap band doctors. I found the doctor first then pulled him up on the list. The faclility that I am going to also was on the list. Process was easy so far (knock on wood) I just called got the pre-auth for the visit. Then the doctors office called BC/BS and was told just to send the phys evaluation, letter from doctor and nutrition consult. So they are sending it today. I am hoping they don't come back with something else. Almost seems to good to be true. Especially after reading how hard it is for some to get approval. I will let you know as soon as I hear. I know that different companies have different policies with BC/BS so yours may be different. Hang in there.

So what is this nutrition consultation? Was that from the lap band doctor? Did you see your primary care physician at any point in this process? You are so lucky! I will keep you posted as I find out more. Good luck... when do you think you will have your surgery? Oh and I noticed you said called and got the pre auth for the visit. Do I need to do that too? I have no idea what I am doing ha ha ha. My doctor wrote me a prescription and so I just started calling doctors.

You can call Anthem and they will send you the coverage information about weight loss surgery. I called on Monday and had it in hand on Saturday. I am going to my seminar Saturday which is required by the doctor that I am using before he will make the appointment. It looks pretty straight forward. They did say that they would require a psych eval and that they would pay for that. There was no requirement about being on a weight loss program for any time period.:thumbup:

Nutrition consultation was required for insurace. It was with one of the nurses at the Weight Loss Clinic. Also required from the doctor. It was to go over your diet once you have the lap band. On BC/BS if it is a specialist you need to see you have to call before you go and get a pre auth. Weird I know I have never had to do that with any other insurance. I want to have the surgery as soon as possible. So I am just waiting on the approval so I can make the appt. They had the 18th & 19th open when I was there last week. That would be great. It is just a waiting game for me now.