mgordon1

I have Blue Cross of CA and for my policy it is there requirement to go to a center of excellence hospital, not a clinic, they require an overnite stay. I am scheduled to have my surgery on Jan 16 at El Camino Hospital in Mountain View, CA. I did not submit a 6 month supervised diet plan, just the doctors recommendation for the surgery and psych eval. So good luck with your journey. I tried to get in by the end of the year, but the surgeon is going on vacation.

My out of pocket is 3000 then everything else is covered at 100%. Also, check and make sure they you don't have a maintenance fee with your doctors office. My original doctor that was going to do the lapband was charging a $5,500 above my deductible. In total, my out of pocket expenses was 8,500.:faint: Once I talked to my Blue Cross PPO they informed me that my follow up for the lapband (fills, labwork etc) should be covered under my office visit . I was referred to another doctor who actually has been in practice longer and teaches the procedure to the doctors in my area. I am very happy with him and my surgery is scheduled for Jan 16 08

I phoned my insurance company on Friday 11-16-07 to check on the status of my pre-auth request and it was approved within three days . This process has been long and not without it's challenges. My first doctor only did the RNY. I was going to go through with it but finally realized it was not what I wanted and then began to pursue the lap band. My second doctor did the lap band, but after research I found out that the $5,500 after care fee above and beyond the insurance requirement was an additional expense was not needed. Phoned the insurance company about the fee to see if it was "standard" that is when I found out it was not. . They were wondering exacting what I needed an additional aftercare/maintenance fee for. I told them that it was for the fills/nutrionist, lab work and doctors vist, they informed me that is what my insurance was for. Asked and received referrals from other lapbanders in my area. Received a referral, call and immediately got in due to a cancellation and took all of my paperwork in. The surgeon was so impressed with my knowledge about the surgery, life changes and what I had brought with me, he told the surgery co-coordinator, book a date and send the insurance information in and needless to say I was approved in three days. Oh I did I mention that they my new doctor did not have a maintence fee, his office staff did not know what I was talking about when I asked that question. They were like the insurance company, that is what you have insurance for. Then I found out that he knew my previous doctor and was glad to take me on as a patient. I was told my fills would be covered with an office visit.- now imagine my surprise I am truly happy, move over here comes another one loser :whoo:.

I have Blue Cross PPO insurance. The schedule told me that she would try to fit me in this year, if not Jan 2008. As far as the other doctor, I can only imagine how many patients he has that have paid the "maintenance fee". Thanks

OK - I am at work and I can't stay on here long. I read my previous post and note to myself, never type when I am tired.Another note, my insurance has a reimbursement provision for hotel and mileage due to the distance (50 miles) Check your policy and see if can get reimbursed for expenses.As far as Dr Coates and Dr Coiran go, they are extremely busy. They mainly due RNY, I can only imagine how busy they will be if they both start doing RNY and lapband.I have a question, for those of you who have already the procedure at Good Sam is there anything that you wished you had done or brought with you. BCBS requires an overnight stay on my policy and I wanted some ideas. Also, is there anything you wished you had done prior to surgery? Thanks in advance for all of your help

Let me understand this, Tricare now approves the lapband????. I am due for to have the lapband surgery in about four weeks. I was so dreading having to pay the deductible and insurance from my job. Please post any information regarding when it will be effective. Thanks

Hi - sorry for the long post in advance - but I think you find it helpful. I have BCBS Prudent Buyer - State employee and I was going to use doctors Coates office to do the procedure. I then found out that the Dr Coiran(SP) only does the procedure and with BCBS they only want the procedure done at a center of excellence with is Good Samaritan Hospital in San Jose to do the lapband. Unless they have changed, Doctors Hospital in Modesto is not a center of excellence and I don't believe either Dr Coates or Corian practices at Good Samaritan. Needless to say, I switched doctors. My new doctor (Dr. Cirangle - Laparoscopic Associates - Weight-Loss Surgery San Francisco, Bariatric Surgery) has an office in San Francisco but does come to the Central Valley and Sacramento on a monthly basis. I have been approved already for the surgery and am schedule to have it done on 11/26 at Good Samaritan. The doctors office was very quick, as I was going to have the RNY done (changed my mind). The only requirment for me was a psych eval (used the same one for the RNY), nutritionist consult, and prior records. Once that was submitted, it only took about two days. As far as the cost, I am paying the 20% deductible to the hospital and they want it prior to admission. I thought it was a payment plan also, I was kindly told no and how much with me when I am going to be admitted. Check your policy also, because my employers policy requires an overnite stay. If you any more questions, email or post.

I live in Northern CA and they do not cover it in Triwest does not covered it. If anyone else has had better success in this area, please post. They cover the civilian doctors to do RNY, but not lapband. Luckily, my job has the insurance that does it, but it is only at 80%. Anyone else had any luck with having tricare to covering the lapband with a civilian doctor?