Blue Cross not paying for fills

[prgb 0]

I wanted to get some feedback from other Anthem Blue Cross LAP-BAND® patients. They have just informed me that they will not pay for adjustments/fills. They believe it is part of the surgery. I am appealing their decision. I have a case manager who told me the first three fills were covered by BC.

I would love to hear about others experience with BC.:smile2:

[gbakerc 2]

I have BCBS of California and they cover fills. There are many different policies for bcbs depending on your specific policy,

[ElfiePoo 109]

I have BCBS of Michigan and they pay for fills.

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[mhmommyx3 0]

I have BcBs of Rhode Island - I was very shocked too because they do not pay for my adjustments. My MD office said this was the first insurance plan they had EVER seen that would pay for an adjustable surgery but not for the adjustments. I tried everything and they WILL NOT pay.

[juliansmom2003 3]

Eeek. I have Keystone Health Plan East of PA (a BCBS plan) and I'm still waiting to hear if they will cover it. My fill is on Thursday, so it would be nice to know!

[finallyncontrol 1]

I have Blue Cross of Alabama and they do not pay for LAP-BAND® at all..not the surgery or the fills. I am completely self pay!!!

[GwSoccermom 0]

I have bc through the city and even thought they originally turned me down, my other doctor got together with my surgeon and got me approved. The first three months were free, then I just have to pay the $20 copay. Of course, all plans are different even within the same company. Good luck

[hmarko 0]

I have Empire BCBC (NYC) - and they even covered the fill from the NP and many insurance companies require the Dr to do it. I believe that it is Anthem too?

[ElfiePoo 109]

I went in for a fill last Thursday and asked them about this. I was told that some Blue Cross plans only cover fills for 90 days after surgery...another reason to push your doctor for fills on your schedule instead of theirs. Can you imagine having to pay for 4 or 5 fills out of your own pocket when insurance would've paid for them if they had just done them sooner and more aggressively?

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[Becky Lou 0]

Hi Hmarko,

I have Bc/Bs Empire too. I am sending in all the paperwork for approval next week sometime. All the tests have been completed. Now my insurance doesn't have alot of requirements. Physc eval and a letter from the Md stating it's medically necessary.Can you let me know how

your process went. I'm so nervous for the approval.

[hmarko 0]

Becky Lou - my doc's office told us what they needed and handled the insurance companies themselves. When I was doing it they wanted the 6 month medically supervised thing.... by month 5 i was into it they dropped that requirement. I did need the doctors referall/ letter too of my history. I was at 40 BMI so well into the qualified zone without the comorbidities though I am also diabetic they needed two comorbidities at 35 bmi.

[prgb 0]

I find it completely unfair, if a case manager from BC tells you that your first three fills in the first 90 days are included and then you're told they are not. BC is now saying that after the first 90 days fills, will be reviewed for medical necessity. If you don't get your band adjusted how are you suppose to resolve your weight, I explained most Band's are placed without being filled. I am hoping to change the critiera at BC and I am hoping I will start a class action change that will allow for fills to be covered at least within the first year of the Band's placement. Thanks for all the responses.

[Nancy6015 0]

I have BCBS of Michigan and they pay for fills.

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I'm happy to hear that ... I have BCBS of Michigan, as well, had surgery January 6th and have not had a fill as yet.

[Wordsmyth 0]

I find it completely unfair, if a case manager from BC tells you that your first three fills in the first 90 days are included and then you're told they are not. BC is now saying that after the first 90 days fills, will be reviewed for medical necessity. If you don't get your band adjusted how are you suppose to resolve your weight, I explained most Band's are placed without being filled. I am hoping to change the critiera at BC and I am hoping I will start a class action change that will allow for fills to be covered at least within the first year of the Band's placement. Thanks for all the responses.

I agree with you! It's counterintuitive to cover the surgery but not the fills, isn't it? I'm in CA too and I just assumed they would cover it, but now I'll have to find out.

Does anyone know what fills cost on average?

[hmarko 0]

I will need to see if they continue to cover the fills too. To be honest.. I got to where I was supposed to be by month 3 and I was going in every 3-4 weeks the first 3 months. I like to go every month though to the doctor and they want us to - to make sure we are on track and suddenly we don't need a fill without recognizing it. My 4th month was Jan, and I went there but got no fill and I didn't think I needed one. Feb - I prob won't need one either at this rate. But i am still going ... I feel like I want that check in for the first year.