brew44 0 Posted January 30, 2010 Hi Everyone! I am just starting the process to try to get approved for the lapband surgery. I was wondering if anyone has experience with BC/BS OK? I recently switched from a PPO to a HMO because it said bariatric surgery was covered. I haven't been able to find any information on what surgery or the requirements for it. Please Help! Share this post Link to post Share on other sites
Tweety39 0 Posted January 30, 2010 Hi Everyone! I am just starting the process to try to get approved for the LAP-BAND® surgery. I was wondering if anyone has experience with BC/BS OK? I recently switched from a PPO to a HMO because it said bariatric surgery was covered. I haven't been able to find any information on what surgery or the requirements for it. Please Help! Hi go onto the insurance web site (look on the back of your card for it) and do a serch on bariatric surgery. hope that helps a little Share this post Link to post Share on other sites
Ms. RJ 1 Posted January 30, 2010 You can also call them and get them to mail you a copy of the policy. I had the surgery with BC/BS and my policy required me to be on a 6 month diet and have a BMI over 40 along with a psychiatric evaluation. Share this post Link to post Share on other sites
honk 780 Posted January 30, 2010 I have Anthem (NY) BC/BS. I had my initial consult Nurse Practiioner/Psych/Nutr. on 12/27. I got a call from the insurance on 1/27 saying they were approving my surgery and gave me a surgery date. I told them that due to a treatment of a blood clot that I would not have clearance from my neurologist to get off the blood thiners I am taking until after 3/8. They said to contact them when I had clearance from the neurologist and had scheduled a date with the surgeon. I do not have comorbidities. I did have a blood clot in the brain earlier this year that was very scary, but knock on wood is responding well to treatment. Due to a knee issue I have been exercising nearly dailey for the last 16 months. When I went to my first consult I brought a print out from my gym showing my attendence (everytime I check in the computer logs it). If you are going to a gym I would bring those records with you to the doctors office as they send that information to the insurance company. Share this post Link to post Share on other sites
debe9455 0 Posted January 30, 2010 Hi, I had BC/BS of Ga and it paid for nearly everything. The remained of the cost was manageable. Share this post Link to post Share on other sites
Astrasmom 1 Posted January 30, 2010 I have BC/BS of NJ, but mine is a PPO. I have coordination of benefits with my husbands insurance which is also BC/BS ppo. I had no problems with them at all. I had to do the 6 month nutritional visits but I was approved with no problems. Because of the double insurance it has costed me nothing. Share this post Link to post Share on other sites
brew44 0 Posted January 30, 2010 Thanks for your answers! I will get started on that. Did you have a family doctor that you went to? If so, who? I am fairly new to Oklahoma and am lost when it comes to picking a decent doctor. Or did you get a hold of a surgeon and go that way? Which is the correct way to start? Share this post Link to post Share on other sites
DianaG 0 Posted January 31, 2010 (edited) Hey Brew, I have BC/BS Federal Employee Program, Standard Coverage and it did pay for my surgery. Every policy seems to be different because, as I have learned from people on this site, it depends on who you work for and if they have agreed to let this type of surgery be covered. It is not up to BC/BS, but up to the company, employer, etc. that you got your insurance through. I do hope you have good luck and are able to get the surgery paid for. I don't think I would have had a chance to get it done if it were not for the insurance..of course the insurance premium I pay is pretty high, but not as high as others, and I would have not been able to pay for the surgery on my own. Good luck to you and please let us know how it goes. Edited January 31, 2010 by DianaG added word Share this post Link to post Share on other sites
meandtheboys 8 Posted January 31, 2010 I have bcbsnc ppo and they paid for everthing and gave me approval in 24 hours.like the pp suggested, go to the website and look up morbid obesity. Our policy required psych, nutritionist, at least 5 years of morbid obesity and documentation of attempts - no 3 or 6 mos evaluation requirement.they made it bery simple and the people on the 800 line are very helpful.if you have identified a Dr, check with their staff to find out specifics since they do this all the time and have lots of info. Good luck and keep us posted! Share this post Link to post Share on other sites
brew44 0 Posted January 31, 2010 Hi! I have tons more questions. I don't really have a primary physician so should I talk to a lapband surgeon or pick a doctor as my primary and approach them? I am pretty sure that one of the requirements is a 6 month diet. How much weight do people actually lose on this diet? What is the point of the 6 month diet? Misty Share this post Link to post Share on other sites
darby 0 Posted January 31, 2010 Thanks for your answers! I will get started on that. Did you have a family doctor that you went to? If so, who? I am fairly new to Oklahoma and am lost when it comes to picking a decent doctor. Or did you get a hold of a surgeon and go that way? Which is the correct way to start? I recommend talking to your family doctor. He or she can recommend a surgeon. I researched the surgeon online after the doctor's recommendation. The Weight Loss Clinic took care of contacting my insurance companies and getting approval for me. Share this post Link to post Share on other sites
brew44 0 Posted January 31, 2010 Hey Brew, I have BC/BS Federal Employee Program, Standard Coverage and it did pay for my surgery. Every policy seems to be different because, as I have learned from people on this site, it depends on who you work for and if they have agreed to let this type of surgery be covered. It is not up to BC/BS, but up to the company, employer, etc. that you got your insurance through. I do hope you have good luck and are able to get the surgery paid for. I don't think I would have had a chance to get it done if it were not for the insurance..of course the insurance premium I pay is pretty high, but not as high as others, and I would have not been able to pay for the surgery on my own. Good luck to you and please let us know how it goes. Diana, I work for OU here in OKC. I am told it is a state paid position but have no idea if it is federal BC/BS. I have BlueLincs HMO and it says that bariatric surgery is 'covered' whatever that means. Will requesting a copy of the policy tell me what WLS it covers? Thanks, Misty:confused: Share this post Link to post Share on other sites
DianaG 0 Posted February 1, 2010 Hi Brew, If you are a state employee then the insurance will not be the federal employee insurance, but it is probably very similar except that the specifics of the policy may have a few different twists and turns. For example, the BC/BS I have did not require the 3-6 month pre diet, but I know that other BC/BS policies do require it. Sometimes if the ins. co. doesn't require it, the medical facility, or surgeon will. It can get really confusing! I think it would be a good idea to request a copy of the insurance policy. You can also call and ask a customer service person about what exactly is covered. Then follow up with the request for a copy of the ins. policy. I imagine they have coordinated with your HMO on what is covered. From what you wrote, it does sound like they do cover the surgery, but it is always a good idea to make really, really sure which procedures they cover. Also, do they cover the pre-surgery testing, appointments with diatitians, psychologists, surgeons fee, and hospital costs? Does your insurance have a list of "preferred"physicians and facilities? It is always a good idea to get a referral from a doctor you trust and who has your best interest in mind. I was lucky in finding my surgeon, as he was recommended by my primary care physician and just happened to be the same surgeon who removed my gall bladder several years ago!:confused: They are both on the "preferred" list of my ins. co. That was a relief! Good luck and please let us know about your progress. There are really great people on this site that are always willing to help. Share this post Link to post Share on other sites
DianaG 0 Posted February 1, 2010 Forgot to tell you, I have a friend who lives in OKC. You aren't too far from where I live...over here in the Ozarks. Share this post Link to post Share on other sites
brew44 0 Posted February 2, 2010 (edited) Thanks for being so helpful. I went online and tried to do some research for my BlueLincs HMO plan for OKC but couldn't find anything except for BC/BS information on programs set up to help you lose weight. I couldn't find anything under gastric, banding, weight loss surgery, etc. I have been trying for quite a few days to actually get someone from customer service on the line to request my policy information. If I ask them point blank about the bariatric surgery will that disqualify me for getting it? I had BlueChoice PPO for a year then on open enrollment I switched to the HMO because it stated in the condensed version of benefits that bariatric surgery was "covered." That is what I am most afraid of. I have wanted this surgery for over 3 years now and I am afraid that somehow I am going to get disqualified. Are there any other questions other than the ones you listed that I should ask when calling them? Misty Edited February 2, 2010 by brew44 Left out a sentence Share this post Link to post Share on other sites
