Band to Sleeve Question - Federal BCBS insurance

[sbingram12 1]

Has anyone who switched from band to sleeve here had Federal BCBS insurance? Can anyone tell me about their process? I've had the band for about a year and a half and I'm right back up to BMI 40 and I STILL have my two comorbidities - PCOS and insulin resistance. Can anyone tell me any information about their process with Federal BCBS and getting switched to the sleeve?

Thanks in advance!

[Morgandobes 0]

Hi

I had my band removed using Anthem-bcbs which is what my work has.

But they wouldent cover the sleeve. So, I am secondarily covered thru my husbands insurance, and the approval went right thru the first time.

Weird thing is, my docs insurance person called one of the case-nurses when we were first planning on submitting the claim, and she told us that they rarely covered

the sleeve as a one part procedure, that it was hard to get thru.

So, to get a denial letter and a base for an appeal, we put the application thru.

It sailed right through, without a second glance from federal bcbs.

There is a thread in the insurance section about this topic also.

Lisa

[sbingram12 1]

So federal bcbs approved you for the sleeve pretty quickly? I'm excited! They approved my lap band within 24 hours and I was really happy about it, so I was hoping they'd have the same response time for the revision to the sleeve.

[Morgandobes 0]

I think it took like 3 days. Which is still pretty decent turnaround, good luck to you!

As far as having the band out, the big thing is your doc showing medical necessity.

And the key to that is to get a doc who has done quite a few so they can slant the wording a bit if you need it. Cause its money in their pocket too.

Lisa

[brittu 42]

Federal BCBS covers the sleeve and with your current BMI you shouldn't have any problem. The local BCBS that administers might stick you with the "investigational" claim but it's easy to fight on first appeal.

In case you need it, here are the letters I've written. My revision was an insurance mess because my BMI was too low, I would have been approved right away with a 40.

My Revision Appeal: From Lap Band to VSG

Britt

[sbingram12 1]

@brittu ok cool (well not cool, but you know what I mean.) Thank you! I really appreciate you letting me see that letter!