Premera?

[shoppinmama 9]

Hi, new here and totally new to everything about the lap band! I was wondering if anyone was familiar with Premera (Microsoft) and their approval process? I have a BMI of about 40. What do they require to get approved, how long does it take, etc. Thanks for any info!

Sarah

[Grider 92]

Its a form of BCBS so I looked on line, and you need to call your ins co directly or HR at your job, they list them all with check your policy in red letters, An employer can Op-out for their area, so no blanket answer

[fuego222 0]

Hi, I'm brand new too and have just started looking into Lapband. I did talk to Premera (not with MS, with Starbucks) and they gave me the following info --

To qualify you must -

Have a BMI of 40 or a BMI of 35 with 2 related issues (diabetes, hypertension, etc.. - I don't remember the whole list)

Then, when you go to actually get approved, the procedure has to be determined to be medically required. That was another list of criteria such as 6 months on a doctor supervised diet plan prior, the related diseases are not responding to/controlled by medications, etc...

Net, I have a BMI between 35 and 40 and am on blood pressure, cholesteral meds and have type 2 diabetes (with meds). But because I'm doing medically well on all those medications, they wouldn't cover me for the procedure. On the plus side, the woman who answered the phone for Premera was very helpful and shared all the info she could find with me.

So I'm looking at self-pay which is $18-22k. I have a friend that highly recommends it and has lost 100 lbs, but I'm meeting with her for a full discussion later next week. I love sweets, and I'm nervous that I won't be able to change my eating habits regardless. I've dieted since the beginning of time, but I always lose weight then gain it back within 12-18 months. I'm fine with getting exercise, but am very nervous about successfully keep weight off and going back to my eating habits/regaining.

Hope that helps.

[ForMeToo 0]

Hi, new here and totally new to everything about the lap band! I was wondering if anyone was familiar with Premera (Microsoft) and their approval process? I have a BMI of about 40. What do they require to get approved, how long does it take, etc. Thanks for any info!

Sarah

I am also Premera (MS). I just got off the phone with them. Abbreviated version of the policy is 100% covered for allowed billable amounts (so go in network). Contingent upon failed diet/lifestyle changes, BMI of 40, or BMI of 35+ with two complications such as diabetes, heart issues, sleep apnea etc.