Blue Shield EPO anyone?

[Yvonne2 0]

:help:

Hi everybody-

I'm a newbie here. I called my insurance (Blue Shield EPO) before setting up consult visit with the surgeon.....was told by BS that the Lap Band was a covered procedure. So.......after the consult visit, the office person who obtains insurance authorization said she had never seen Blue Shield EPO cover the lap band procedure. I called BS again and was told this time that they did not cover this procedure.

Anybody out there ever have success with an appeal with Blue Shield EPO? Or, better yet, have the procedure approved the first time?

Thanks in advance!:help:

Yvonne2

[Alexandra 55]

Yvonne, what state are you in? Blue Shield is not the same from place to place. And who is the planholder--is it a group plan or individual? You should pull out your contract and see what the exclusions are. Don't trust any customer-service rep on the phone to give you accurate information. I only believe things when I've been told them two or three times by different peopole. :grouphug:

[Yvonne2 0]

Right.......I never take the first answer as the final answer! I am in California, this is CalPERS Blue Shield of California EPO.

I have been reading quite a few forums and have yet to come upon someone who has this insurance and been successful with authorization........

Yvonne2

[Alexandra 55]

Well, I don't know what CalPERS means, but if you have yet to find someone who's had it covered you may be up against a big wall.