BC/BS OF Alabama

[amycc3 0]

Does anyone have any recent info on whether or not BC/BS of Alabama is now covering Lap Band? They recently stopped covering gastric bypass and I was told that Lap Band was experimental. I am interested in learning more about the surgery but don't want to waste my time if there is no way AL will cover this. Thanks

[awatter 0]

I also have BSBC of Alabama. I spoke with them a couple of weeks ago and they confirmed that they do not cover the lap band. They do however, cover gastric bypass. They recently changed their policy on the lap band...they still do not cover it..but they scratched out the part about it being investigational. Here is the bookmark for my policy, which is the PPO. Hope that helps.

http://www.bcbsal.org/providers/policies/final/031.pdf

This is their entire policy on Morbid Obesity

http://www.bcbsal.org/providers/policies/final/053.pdf

Angela

[andyisbanned 1]

BCBS of AL has been approving the Lap-Band surgery since April 2007. It may vary according to your policy as to what or how to qualify. My policy will only cover 80% of the surgery but 100% of any follow up for 1 year. I will have to pay about $400.00 prior to surgery. To get approved, you have some hoops to jump thur.

Here is my experience:

1. Your BMI must be over 40 or over 35 with at least 2 of 3 comorbidites (IE: sleep Apnea, High Blood Pressure, Diabetes). My BMI is over 40 and I have Severe Obstructive sleep Apnea (OSA) and High Blood Pressure. Due to my OSA, I have a trach.

2. You must have maintained a BMI of 35 with comorbidites or over 40 for the last 3 years. This is will be checked and verified by your surgeon & BCBS thur copies of your medical records you must have submitted by your doctors to the surgeons office. I was able to have my sleep doctor, my ENT, and my family doctor submit copies of my medical records for the last 5 years which I think helped.

3. If you meet 1 & 2, you must now complete at your expense a 6 month doctor directed diet with your family physician. During the diet, you must maintain a exercise and food journal to document your success or failure of the diet. This stage will require 7 monthly visits, scheduled at least 30 days apart with your family doctor. This is key as BCBS requires at least 30 days between each visit or it does not count. You physician will be required to fill out a paper each month to provide to your surgeon for submission to BCBS. My surgeon provided the form and my family doctor just made copies and gave me the original to send to my surgeon. It cost me about $500 to complete this phase. I finished in December 2007. My family doctor knew why I wished to complete this diet program and was very supportive and understanding. My sleep doctor and ENT want me to get this surgery to help with my OSA.

4. Once complete with the diet, your surgeon can submit your paperwork to BCBS. BCBS will then require a consult with a physical therapist and a nutritionist. These consult visits are to teach you the exercise and diet plans you must follow prior to and after the surgery. I just completed this phase last week. I spent an hour showing I could do the exercises with the PT. I then went and spent the next hour learning how & what to eat. I am putting it to practice now. They say it takes 40 days to make or break a habit. I have learned that some are not required to complete this step, but some also have to complete a psychiatric evaluation. It just depends on your policy.

5. After the consults, your surgeon will re-submit the paperwork with the reports from PT and nutritionist. Now is the time to sit back and wait on BCBS. My approval only took an hour as the surgeon's office file on-line.

6. With approval, I had to complete a pre-op training class (about an hour long) with the surgeon's staff, then have a pre-op physical with my surgeon. Then my date was set. I will have surgery on February 14th.

7. Final step is to get the surgery and start life a new.

I am using Dr. Britt of Marshall Surgical group from Guntersville. They provide a free seminar monthly at the Madison Surgery Center on Lanier Road in Madison, Alabama. They have surgery rights at the Madison Surgery center, Crestwood in Huntsville, Marshall Medical North in Guntersville, and Marshall Medical South.

I hope this helps.

Andy