greendragon

I just found out that I am not covered :smile2: My company, because it is a 'fully-insured' company, does not even get the option of covering bariatric surgery, according to the BCBS representative. If we were 'self-insured', we would be given that option for an expensive rider, but we don't even get that option. So even if I am considered 'medically necessary', it isn't covered. I can't self-pay, so I am out of luck. I've been here for 4 years, and don't even want to consider looking for a different job for different insurance :laugh:

Hi! I'm new here, and have been considering Lapbanding for a long time. However, I figured it wasn't covered by my insurance, as BCBS of Florida (BlueChoice PPO) has a specific WL exclusion. However, I heard one of my co-workers say her friend, with the same insurance, was 100% covered, so I'm starting the ball rolling. Both my husband and I have BMIs over 40. I'm 5'8" at 300 lbs, he's 6'4" at 480 lbs. We both have some co-morbidities (sleep apnea, joint pain, etc.) I've just made a consultation appointment with Dr. Jawal in Ocala, FL, for Sept 5, and hoping for the best. I know I will probably have a fight with the insurance on this. Any advice?

I have BCBS of FLorida and the answer is - it depends. BCBS of Florida does cover it if it's medically necessary. However, there is also a rider that your individual company has to purchase. Some companies (if they are 'fully insured' rather than 'self-insured') are not allowed to purchase it (like mine). So therefore, mine is not covered, even if medically necessary :smile2:

I would also be interested in an answer on this, as we are in similar circumstances. I have BCBS of Florida PPO, have a BMI of 44, but with very few co-morbidities. I believe I have sleep apnea, I do have heel spurs, but I don't have arthritis or diabetes. However, my father has adult onset diabetes, as did his mother, so I'm certainly in line for it. As for attempts to lose weight, I would like to know what records they need. I was on low-carb for six months, I was on Weight Watchers for a year, etc. - does it need to be doctor-run? What sort of documentation do they need?