Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Ugh!! BCBS says experimental!!!



Recommended Posts

I just got off the phone with CareFirst BlueChoice insurance. My DH works for Montgomery County, MD, and apparenty their insurance policy follows the Blue Cross "National" policy and not the "Maryland" policy. Lap-band is covered in the Maryland policy, but the National policy lists it as experimental. They will only cover Gastric Bypass, which I really don't want. I thought I had researched this pretty well, but this totally through me for a loop! Has anyone else dealt with this? Is it possible to get past this via appeal?

Thanks!

UPDATE

I got approved on the first pass! I had my initial consultation on Monday, and got a call Thursday that I was approved. I have a BMI of 40, and had my pysician supervised diet records with my at my consultation. I have scheduled all my pre-op stuff, and am scheduled for 9/18 for surgery. It just seems too easy. I was all geared up for a fight with the insurance company.

Thanks to everyone for their support and encouragement.

Share this post


Link to post
Share on other sites

It's absurd to label a procedure "experimental" that's been in place for five years. My bet is that you can have it reversed on appeal. There is no legitimate justification for calling it experimental at this late date.

Share this post


Link to post
Share on other sites

From our experience with one insurance company that is denying the band they are saying that it is 'experimental' because they believe the gastric bypass is better than the Band. You can consider an appeal and you and/or your surgeon should provide articles comparing the LapBand to the bypass.

Good luck!

Share this post


Link to post
Share on other sites

Thanks! I'm trying to pick a surgeon and get the ball rolling. I just don't want to feel like I'm getting my hopes up if there isn't a chance. I've been out of work for almost a year, and self pay is not an option. The more I read, the more I know I definitely want this surgery.

Share this post


Link to post
Share on other sites

The LapBand was approved by the FDA in 2001, and by Medicare in February, 2006, so by definition it is NOT experimental, and has not been for 5 years. Those two facts should be the focus of your appeal.

Share this post


Link to post
Share on other sites

The LapBand was approved by the FDA in 2001, and by Medicare in February, 2006, so by definition it is NOT experimental, and has not been for 5 years. Those two facts should be the focus of your appeal.

As my note from above, it appears that at least one insurance company is saying the Lap Band is experimental because they are using data showing that the GB is superior. So I suppose what they are saying is that the LapBand is experimental in the sense that the GB is more effective. I think there is a sufficient amount of data to support the LapBand over GB.and

Share this post


Link to post
Share on other sites

I have my consultation on Monday, 7/31, which will get the ball rolling. I picked an in network surgeon, which hopefully will help insurance go smoothly. I will keep you updated. Thanks for the advise!

Share this post


Link to post
Share on other sites

UPDATE

I got approved on the first pass! I had my initial consultation on Monday, and got a call Thursday that I was approved. I have a BMI of 40, and had my pysician supervised diet records with my at my consultation. I have scheduled all my pre-op stuff, and am scheduled for 9/18 for surgery. It just seems too easy. I was all geared up for a fight with the insurance company.

Thanks to everyone for their support and encouragement.

OMG that is awesome!!!!!!!!!!!! You must be soooo excited:clap2: !

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Bashbee91

      Hey guys new to the process looking forward to this new life. 
      · 0 replies
      1. This update has no replies.
    • Bugg

      Hi everyone! I’m brand new here. I just went through all my pre-op requirements per my insurance company and now everything has been submitted and I’m just waiting for final approval and my surgery date. I’ve been doing research, watching YouTube videos, TikTok’s, ect.. trying to prepare my mind and what to expect so I’ll be ready for the surgery. I was so sure and so set and so ready and excited. However, now that I’ve done everything & it’s almost here, I am sooooooo scared! I know why I want it bc I’ve tried everything and I just don’t feel like I can lose weight by myself. I’m tired of being overweight my entire life. I’m miserable, but I keep psyching myself out afraid of GERD bc I know how that can be and I don’t want to have to get a bypass after already gaining the courage to even get VSG. I’m scared of complications like I’mgoing to regret doing it and be depressed that I didn’t just be more disciplined and try again to lose the weight on my own even sitting here typing this knowing in my mind i just can’t and don’t possess the discipline. I’m also afraid I won’t be able to handle the restrictions of the sleeve. What do I eat? I don’t know how to eat healthy really and don’t enjoy healthy food. I don’t know how to do this! I feel so defeated!Someone tell me they felt anything similar to this or am I not ready? I thought I was. I am so tired of being sick and tired and so tired of myself and so tired of being stuck and stuck in this body and somebody different on the outside from what I feel inside. I just want to ball up and cry.
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      over 20 lbs down since4 the pre surgery diet and surgery on the 14th
      · 1 reply
      1. Selina333

        Yay!! Congrats. I know how good that feels. 🤩

    • Jenopolis

      Had a sleeve in 2017, lost over 100 pounds. Had a DS surgery this year (2025) for more sustainable weight loss. 🤞
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      The 14th was my day. I am home and recovery is going pretty smooth. They even let me walk out of the hospital. Picture of me in recovery curtesy of my boyfriend lol. 

      · 3 replies
      1. DaisyChainOz

        Glad it went well!! Wishing you a speedy recovery and wonderful success!! 🤗

      2. buildabetteranna

        Thank you ❤️

      3. Selina333

        Neat you have a pic of this day! I was sooo happy to get my surgery. It was well worth it! And I'm not even near my goal. I had surgery Dec. 2!

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×