airwayman

Do you mean 2006 or possibly 2005? If you are actually talking about 2007, please PM me, we need to discuss the stock market and the upcoming Power Ball lottery.

Stacey, we may cross paths there someday. I, too, live in Charlotte and am a patient of Dr. V. I had my evaluations the other day. Yes, all nice people. I had an appointment with Dr. V. and he approved me for lap band three years ago. I liked him at the time but the insurance was a no go back then and he had only done 7 lap bands. I put it off, next thing you know, it's been three years. I'm back on track, self pay or ins. either way. As of a couple weeks ago, BCBS has begun paying for lap band in NC. I have the new policy straight from the horse's...well, one end of the horse, not sure which. I did find out why they didn't return my calls....the lady I was calling was in a bad car accident. I've talked to a VERY nice lady since and she is really helpful. I have a letter from my PCP and my sleep apnea Dr. supporting my surgery. I see Dr. V on March 2nd. Do you have a surgery date? John B.

I go for my evaluations tomorrow. I've heard people say they wish they'd not said some things on the evaluations because they were not recommended for Lap Band surgery and were instead steered to gastric bypass. Any words of wisdom? JB

Why? Have you read the new policy? It's very thorough and it looks like they really did think it over before putting it in ink. I hope you're wrong but I wouldn't put any money on it.

I just got off the phone with BCBS of NC. The Corporate Medical Policy - Surgery for Morbid Obesity has been changed to include gastric banding (the Lap Band). The representative was most helpful and directed me to the appropriate section of their website. I now have a print out of the new policy in my fat little hand! Besides the same restrictions we've all read about a thousand times (BMI 40 or more, BMI 35 with co-morbities, etc.) there are two other restrictions, 1.) Patient must be over 18 yrs. of age, and, 2.) BMI must be less than 50.

I went to the Drs. informational meeting the other night here in Charlotte. He said he is now using two of the big hospitals in Charlotte for his paitents with ins. The cost runs between 21k and 23k. That doesn't include the pre op consults, I don't think. He went on to say for Lap Band patients who wish to self pay he is now doing them at a outpatient surgery clinic for $14,900 and it also includes one year of follow up by him and his team. I think the pre op consults are not included, I don't think and they are $600. My wife had surgery at this clinic a year ago and I was very impressed...clean, nice place, very friendly staff, very professional, etc. I don't think this clinic handles any insurance cases....just self pays. (In other words they do boobs, noses, Lap Bands, etc.) I'd go there in a heart beat but BCBS of North Carolina just changed their policy and is now approving lap band surgery!! So I guess I'll go to the big hospital.

Some of you have heard my rant recently about calling a direct line to a BCBSNC representative that I have had good luck with in the past. I was upset that I had left her three voice mails in the past three weeks and she had not had the courtesty to even acknowledge my calls. Turns out she was in a BAD car accident about a month ago. Now, you'd think they would have someone checking her voice mails but, still, I feel a little guilty. Oh, okay, now that they have APPROVED THE LAP BAND SURGERY IN THEIR CORPORATE POLICY I guess we can kiss and make up.

See my new post. BCBS of North Carolina just changed their policy to include gastric banding (Lap Band).

Boy am I glad to hear that. I haven't been banded yet but it's gettin' close. I've been practicing chewing and I don't think I'll have a problem with that. But, I sure do miss Water w/ meals. Glad to hear once you get the proper restriction the urge goes away.

My case is different. My employer's policy covers WLS, doesn't say what kind, only that you have to qualify for all the reasons we've all heard a thousand times. It's the BCBSNC policy that specifically excludes gastric banding. I'm on it and will have it out with BCBS-NC, thanks to you and others who have provided me with a wealth of information. I thank you for all you've done. We'll see what shakes out. JB

Yes, but aren't you allowed only a certain number of appeals?

All of the gastric bypass type surgeries, the only one excluded is gastric banding, their word for Lap-Band.

Wow, that's wonderful news. I have THREE calls into the gal I've dealt with at BCBSNC in the past. THREE calls over two weeks. She has not had the courtesty to call and say yes, no, we're working on it or even kiss my grits. Monday, I'm calling until I get a live body. I don't know anything about the support meetings. Did I see on Dr. V's list that I must attend one before surgery? Is there a support group of just bandsters or is it a mix of folks who have had various types of WLS? JB

I was at the meeting Monday night. I thought he said BCBS was NOT paying for lap band surgery as of that date but that he had heard they might possibly if you file a couple of appeals. Has something changed since then? Hope so! JB

It's not the company, my benefits book says they pay for qualified weight loss surgery...it just doesn't say what type. It's the BCBSNC policy that says gastric banding is 'investigational'. BCBS in South Carolina is paying for Lap Band surgery and North Carolina is not? That's bull***t!!

I don't understand...you live in Kansas City area but have BCBS in South Carolina? My company insurance booklet covers 'weight loss surgery for the morbidly obese, provided the insured meets the following criteria' (and you know what that is). However it doesn't specify the type of surgery it covers. The BCBSNC policy for Morbid Obesity is the one that excludes 'gastric banding.' I have left two messages with a BCBS rep over the last two weeks. This person has not even had the courtesy to call and say, NO or HELL NO, or, hopefully, that they are looking into it. This reminds me of getting my driver's license renewed....you have no choice....what are you going to do...go somewhere else? Arrrggghhh. JB

MEW, I certainly don't want to be branded as 'that negative Airwayman' but I don't want people to get their hopes too high. You are in a different state, things may be different, hopefully. I went to my doctor's Lap Band seminar last night here in Charlotte. He and his office ins. guru said, at the present time, BCBS of North Carolina does NOT cover gastric banding (read Lap Band). My BCBS policy DOES cover WLS but only the R-N-Y or a couple of the other invasive, gut cutting jobbies. It has an exclusion for the Lap Band. Yes, CPT 43770 is the correct code for gastric banding. The doctor even gave us that code last night so we could use it in a fight with BCBS. It, however, doesn't mean they'll pay for it. Providing the correct CPT code to your insurance carrier just insures that everyone is on the same page and is talking about the same procedure. The last thing you'd want is for them to approve your surgery thinking it was one of the approved types of WLS, and once you have it, they realize it was for the Lap Band and they don't cover it. The unofficial word around here is BCBS has paid for a few gastric bandings lately but only after you burn through a couple of your appeals. I have no proof of this...just a rumor. I am going to self pay, here's why: My doctor said he can do the surgery in the two name brand hospitals in Charlotte if the patient was going the insurance route but, starting next month, he can do them at an outpatient surgical center (my wife got her boobie job there...its a nice clean place). No overnight stay, and more importantly, a huge discount. The hospitals vary from 19,000+ to 23,000+ for Lap Band surgery. The cost of doing it in the outpatient clinic, plus one year of fills, office visits with my Dr. is $14,900. Tax, Title, license. The reason for the dramatic difference in cost is that when you use the outpatient clinic it's self pay only. The doctor and the clinic are giving a 25% discount if they don't have to screw with the ins. companies.

WLS is covered by my North Carolina BCBS policy...but not the 'gastric band' as they call it. Lots of talk (talk is cheap) about them slowly changing the policy. Some say it may be possible but only after you burn through a couple of appeals. I have no proof of this. JB

Rats. I was hoping you covinced BCBS they are being foolish to call this 'investigational.' Good luck!!

What is the name of your insurance company?? JB

Hi all. I'm going to my prospective doctor's Lap Band seminar tonight. I have been reading LBT for a while and have quite a list of questions to ask. Can some of you with past experience tell me some of the questions I really need to be sure and ask? (Forget the ins. stuff. BCBS won't even call me back to discuss my voice mails on the subject). Thanks, JB

Hope I'm not being too nosy but who is your insurance company? Where did you have your Lap Band surgery done? What did it cost? JB

Wow, thanks, had no idea they had adjustable breast implants. Next thing you know they'll have a remote control.

I agree and that's a good idea. I'll tell my wife that in 2 months on our 35 anniversary.