airwayman

There's an old saying: "You can't change a tiger's stripes." Women will always be beautiful to men. No one taught me that, it just came naturally when I was...oh, four years old.

Ha! Susanah, what a great choice of a word....'widespread.' That one word pretty much covers all of the 48 contiguous states. I haven't been to Alaska or Hawaii for a few years so I can't include them. Been to all the others and, yes, it's 'widespread' in all of them. P.S. What's a new platform 10cc band??

This is all very interesting. One doc says to take tiny sips to help liquifythe food, one says to stop drinking an hour or more before meals and several Drs. had instructions in between. Hmmmm. Guess we have to figure this out on an individual basis. What works for one might not work for others. This may bring up some debate but a year or so ago I was listening to NPR? maybe...can't remember. The program had several specialists on the panel and the discussion was on water intake. ALL of the doctors and specialists without a single opposition, said this notion of "drinking 8 glasses of water a day" was totally unnecessary. Some said they heard it 'flushes the system' not true they said, once you're hydrated excess liquid just makes you pee more often. Not necessarily a bad thing, according to them, just unnecessary. The moderator asked where this notion that drinking 89 glasses of water was good for you...none had an answer. They agreed that unless you're doing exercise and sweating you actually get almost all the water you need from food! One lady said she has written books on water and she still has no idea who thought you needed all that water. The panel went on to say they've tried to find out who takes responsibility for this '8 glasses a day' idea. When pressed, every so called expert said "well that's what they say....everyone knows you're supposed to drink that much." They never did find out who "they" was. It was an interesting program.

I agree AGB surgery is newer (in the U.S.) than some of the other types of bariatric surgery. But how long is BCBS and some of the other insurers going to use this excuse....calling it 'investigational.' Fact is, it works. There's tens of thousands of case histories all over the world and a growing number of those are done in the U.S. The risk/benefit to the patient is well documented. The potential savings to the insurance industry should be a no-brainer. Wonder why they're dragging their feet?

Yeah, but isn't this just for gastric bypass? I couldn't find anything about gastric banding in this document. JB

The key phrase in the document is noted above. My BCBS won't pay for procedures that are classed as investigational. Once again, I am NOT trying to be a pessimist, just want pass along the info that I've received. I have a call into BCBS in my home state of NC and will vigorously fight them on this 'investigational' wording. Thanks for all the good information you have given me. JB

WLS is definitely on my BCBS policy, too....only under items not covered is d.) gastric banding.

And this was for Lap-Band surgery?? What is BCBS "Anthem?"

Long story a little bit shorter... our Contract with bcbs IS inclusive of WLS, but it does have to be medically necessary, which has to be proven by doctors documentation.. if you've read my entire thread you will see emails from REAL bcbs people.... and their admission that we are covered. The insurance guru at the docs office spent 45 minutes on the phone with them (on hold) when finally.... they said YES it is covered under the following criteria: 1. BMI over 40 or 35 and 2 comorbitities 2. Letter from a psychologist stating that I am of stable mind to make my own health decisions. 3. Letter from a Nutritionist Eval. (I used the one referred to me by the docs office) *NOTE: NO 6 month supervised diet *** After I get the letters to the doc, she then submits everything to the BCBS for the claim number to be assigned.. at that time I will schedule my date. It's not the coverage for WLS that worries me...I have the BCBS of NC Corporate Medical Policy titled Surgery for Morbid Obesity last updated August 2006. And, my company insurance covers WLS (doesn's say what type, just that if it's deemed medically necessary, it's covered). The problem is buried back in the BCBS policy under the heading When Surgery for Morbid Obesity is Not Covered, item No. 2 subpart d. says 'gastric banding.' Has anyone out there who is covered by BCBS actually had gastric banding surgery, submitted a claim and had it paid? Please let us hear from you.

The medical codes are what are standard use in the field of medicine for a diagnosis and a code for medical purposes to process the paper work. It's on the web. No big surprise. Just go to BCBSNC's website and log in with your member number or as a guest. Your searches should be one word "gastric" "bariatric" or "obesity". Yeah, did all that yesterday...got my subscriber no. etc. and entered BCBSNC's site. I looked all over the site.....used the Search, etc. and nary a word about approving gastric banding. I found the Corporate Medical Policy on Surgery for Morbid Obesity (you had already sent me the link) and I read it from stem to stern hoping it had been amended..nope. I could NOT find the press release from the TEC wherein the MAP concluded that laparoscopic gastric banding met their criteria. I have a private number for one of the BCBSNC's representatives...a lady I have had good luck with in the past on unrelated issues. I gathered all my stuff and called to discuss. All I got was her voice mail but I left a detailed message on this specific issue. I asked her to call or email when she found out anything. I'll keep you posted. Again, many thanks for your help. JB

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read) https://www.bcbsnc.com/services/medi...id_obesity.pdf Where did you find this code? Is it significant?

Hey thanks for the link to the Inamed site. Wonder why there are TWO different lap bands sold by the same company? Anybody know the answer?

Hey thanks for the info. Wonder why there are two types of Lap

Thanks for your info about Dr. V. I'm sure hoping this all works out. Did ins. pay for yours? How do I do the PM thingie?

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read) I read the whole link, I didn't see that medical code anywhere. Where did you find it?? Thanks!

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read) https://www.bcbsnc.com/services/medi...id_obesity.pdf Hi, thanks for all your efforts!! However, in reading the link above, on page 6 (they're not numbered) under Procedures NOT covered, Item D is Gastric Banding.

Wow!! You are something else, Lap Dancer. I read the NC policy on morbid obesity (you sent me the link) it DOES NOT cover ABG but I also read the link you sent where it they removed the investigational wording. I plan to call those thugs on Monday. No, I won't get mad, I just plan to have my pit bull face on. I'll keep you posted. JB

A few days ago I called BCBS in my home state of NC. It went something like this: Ring....Ring. Them: BCBS of NC may I hep you? Me: Yes ma'am. Just wanted to check on weight loss surgery coverage. Do you provide coverage for the adjustable gastric band? Them: Hmmmm......A what...adjustable...(trailed off)...jest a minute, lemme check with my super. Me: Read the entire paper, sing all verses of 98 Bottles of Beer on the Wall, fill out income tax for next 4 years. Them: Hun, you still there: Me: ZZZZZZZZZZZZ Them: HEY!! Me: Yeah, yeah I'm still here!! Whad you find out? Them: Is that a roax and Y? Or a duo-something-or-another switch?" Me: No ma'am, a gastric band, maybe it's called Adjustable Gastric Band, a AGB, gastric banding or a trade name like LAP-Band, perhaps?" Them: Yeah, here it is....an adjustable gastric band? Me: YES!! That's it!! That's it!! Them: Nah, we don't cover it. Says here it's "investigational?"

I HATE to burst any bubbles but, Tracy, did you specifically tell BCBS you were having LAP-BAND surgery? Yes, the cover weight loss surgery, RNY, duodenal switch (or whatever it's called) but NOT the LAP-BAND. This from the horse's mouth (or some part of the horse) from BCBS North Carolina as of yesterday. Most of the worker-bees you talk to know weight loss surgery is covered if you hit the BMI mark, have documented weight loss failures, etc. etc. But, what they don't know is the types of weight loss surgery that's covered. If you specifically ask them (which I did yesterday and have done in the past years) "do you see where AGB procedures are covered" the answer always comes back...."oh, is that gastric banding....no, it's not covered." I hope I'm wrong, really I do. I am going to have to self pay next month if you can't help get these idiots to realize the benefits (and future cost savings) of the AGB.