Insurance

Mellie · January 19, 2006

I'm just curious to know what NC insurances have paid for the LapBand. I have been getting nowhere with BCBS and my patience is wearing thin. I don't know if I should try a lawyer or what I should do next. Please help, any information is much appreciated.

Denika · January 20, 2006

Hello Mellie,

I don't know much about which insurance companies HAVE paid for it, but I know one that doesn't! I'm a teacher, so I have the Teachers' and State Employees' Insurance, which absolutely positively would not pay for it. I think United Healthcare does maybe? I don't know, hopefully someone here can help you more than I can!

Denika

jttaurus · January 20, 2006

The insurance depends on your policy, everyone is different. At huge corp where I work they cover lap band and rny with UHC. THey don't offer blue cross and blue sheild.

As for the 'price' the dr's office should be able to give you the price, don't forget insurance companies negotiate 'huge' discounts with dr's so what tehy pay is usually way less than someone paying cash.

Dragonwillow · January 20, 2006

I have United Health Care choice plan and had no promblems getting coverage. If you go to, I think Obesity Help.com you can look up I think NC lap band doctors and then you can see what insurance companies their patients that are registered had. But like someone else said, its probally based more on the particular plan than the company.

Good luck

Melissa

January 22, 2006

Denika,

I was wondering if you could tell me a little about your experience with the State Health plan. I am also a teacher, and I have requested the surgery and was told by the review committee that they do cover this procedure. My surgeon's office checked into it as well and said that they had several patients who had lap band that was paid for by the State Health plan.

So, what happened in your case? I am getting ready to turn in all the paper work and need to be prepared. Thank you!

Denika · January 22, 2006

Hey JamieLynn,

I'd be happy to let you know what happened with me. I also want to say that up to this point, I have been very happy with our insurance. They have always paid what they said they would, and even helped a great deal with our fertility treatments, shots, and all that stuff.

When I first started with this, I called to give them the "surgery code" like I was supposed to do. When I did, I was told that they would cover the band. When I called my surgeon's office to tell them, they said that they had tried repeatedly to get them to cover the band and that they would not. They said that I needed to get them to put it in writing. So, I called them back, asked about the surgery code again, and told them that I needed them to write it in a letter that it could be covered. (They did say the review board had to approve it to be medically necessary.) They acted like that was the craziest request that they had ever received, but did send the letter. When I gave it to my surgeon's coordinator, she said that she knew that they would not cover it. She said that "we are a center of excellence for Blue Cross Blue Shield, and I KNOW that they do not cover it." I told her that my family would help me to self-pay, but that I thought I owed it to them to at least TRY to get it approved before I let them fork out money or collateral or whatever to help me get a loan. She said she would file it, but I don't know that she actually did. I'll be honest, at that point, I was so happy to have all of the pre-op stuff out of the way and to FINALLY have a surgery date, that I didn't worry about it as much as I should have. But now, my almost $500 payment is getting old every month! LOL!

Please keep me updated about your approval process. I hope they do cover it for you! They should, because it is so much safer than the bypass.

Denika

Sherrie · January 24, 2006

Just called BCBS yesterday - because we changed insurance. They do NOT pay for Lapband... but they DO pay for Gastric Bypass.

I paid out of pocket in Mexico -- but I was hoping that my new insurance might pay for fills.

NOT!!!

Mellie · January 24, 2006

Thanks for the replies. I was hoping that someone had gotten BCBS to overturn their decision. Anyway, I think I'm going to get in touch with a lawyer and see what steps I need to take. I can't pay for it myself and I don't want the RNY.