blue cross blue shield

[maltomeel 0]

I'm Empire BCBS in NY. I received my final results from my Apnea testing and I do have mild apnea. I have to say that I've never been so happy to hava a malady! I hope the Pulmonologist will fax a letter confirming this to my surgeon tomorrow....and then we submit! Whew.

So, BMI over 40, over 5 years morbidly obese, psych eval, nutritional eval, 6 months "letter" of progress from PCP, Esophogram, EKG, Echocardiogram, letter from chiropractor re:osteo, CT scan of fatty infiltration of my salivary glands and liver (yes, even my glands are FAT), PCP letter of failed diet attempts, letter of support from my Endocrinologist (med controlled hypothyroid BTW). Hoping this will suffice. I did also have gestational diabetes but I don't think it counts, as it is not currently KILLING me.

I'm a little sarcastic this evening..but I am so beyond excited, nervous, anxious......

Please send me some good vibes.

Oh, BTW, after 2 weeks of daily, intense excercise and dieting...I gained a pound according to my PCP's scale. I wanted to cry.....I need this help so badly.

Jill in NY

BMI 41

246/???/175

Dr. Mayer, Huntington NY

[kwhenrykerr 0]

I read another post that had an idea. Have your doctor repair a herina and pay for the lab band self pay. The insurance pays for the large portion of the two opperation. I am told that 80% of overweight people have a herina.

[singdeborah 0]

I had dinner with a friend the other night who actually works for bcbs and she acted like it would be a piece of cake. That approval wasn't that much of a problem anymore. She doesn't do the approving herself but is definitely involved in knowing how things go. She's been there about 20 years. She definitely gave me the opinion that it was not a problem.

[singdeborah 0]

Where are you located flowergirl? I have not even heard that about bcbs fed. They took our insurance cards at the seminar and said immediately "no problem". Everyone seems to know my insurance and has said over and over again, "no problem". Perhaps there is another center in your state. You won't have to self-pay.

[rcoeters 0]

I was fighting in NC and learned that BCBS of NC approved Lap-Band at the end of January 2007. I'm finally on the OR schedule!!!

Good luck to you.

[airwayman 2]

I'm discouraged already and haven't even begun the process.

I attended the seminar last night but was told that the surgeon refuses BC/BS Federal (group 105) as they do say that they cover banding but will not giver prior authorization or approval...just get it done then send in the claims...apparently, when that is done, BC/BS is not paying! I'm so disappointed. Anyone with this plan have same problem? I cannot afford to self-pay at this time.TIA!

So sorry to hear you are discouraged, but, listen to me and others....keep up the fight. Things are changing at BCBS...you will win in the end. Keep the faith and keep the pressure on.

[ard 0]

Hi Everyone,

This is my first post. Thank you for all the information I have obtained from this forum. I have a question. I'm going throught the process of getting the required tests completed, only test left to do is the sleep study which is scheduled for next week. The surgery has not been approved yet but my surgeon informed me that my insurance Horizon BCBS NJ HMO will more than likely pay for the lap band procedure and the surgeon's fees but not for the port which is an out of pocket fee of $2000. Has anyone else had to pay this fee? Just wondering. Thanks

[airwayman 2]

The surgery has not been approved yet but my surgeon informed me that my insurance Horizon BCBS NJ HMO will more than likely pay for the lap band procedure and the surgeon's fees but not for the port which is an out of pocket fee of $2000. Has anyone else had to pay this fee? Just wondering. Thanks

The port is a part of the Lap Band, not an accessory like fancy hubcaps on a car. Are you dealing with a reputable bariatric surgeon who is familiar with this procedure? How could any ins. co. justify saying the port was not necessary part of the procedure? Anyone else ever heard of this? JB:confused:

[Lap_dancer 8]

The port is a part of the Lap Band, not an accessory like fancy hubcaps on a car. Are you dealing with a reputable bariatric surgeon who is familiar with this procedure? How could any ins. co. justify saying the port was not necessary part of the procedure? Anyone else ever heard of this? JB:confused:

Originally Posted by ard

The surgery has not been approved yet but my surgeon informed me that my insurance Horizon BCBS NJ HMO will more than likely pay for the lap band procedure and the surgeon's fees but not for the port which is an out of pocket fee of $2000. Has anyone else had to pay this fee? Just wondering. Thanks

OMG! Never. How crazy is that. You know what I'm thinking? I'm thinking that they will PAY for the S-U-R-G-E-R-Y because they do cover surgeries in insurance companies, but they do not cover WEIGHT LOSS surgery. So if you remove the cost of the device for weight loss, the SURGERY would be perfectly covered under the insurance plan. That's the first thing that came to mind. ((???))) who knows? Maybe they are in a round about way trying to get it done whatever it takes?

[ard 0]

I was thinking the same thing about the port. Why do the surgery and leave out the port as if it's an unneccessory accessory. I'm going to call the insurance company to check on this too. Thanks

[airwayman 2]

I was thinking the same thing about the port. Why do the surgery and leave out the port as if it's an unneccessory accessory. I'm going to call the insurance company to check on this too. Thanks

Many of us, me included, seem to think it's "us against the ins. companies." Especially when it comes to WLS, and specifically the Lap Band. It is relatively new and ins. companies were understandably cautious about approving something without positive scientific evidence and studies that it worked. The jury is in, the lap band studies do support the claims for substantial weight loss. BCBS and others are rapidly coming online and paying for the procedure. In your case, the best advice I can give you is to call your ins. rep. Ask for a representative who is familiar with WLS. They should be able to lead you, online, to the corporate medical policy area. Your ins. co. will have a written policy for WLS and it will tell you exactly what they will pay and what is excluded. My BCBS rep. pointed me to the site and I printed out the policy for NC which was modified around Feb. 1st to specificially include "gastric banding (a.k.a lap band) as an approved procedure. I can't possibly imagine a company who would approve a procedure where a necessary part of the medically implanted device is not covered. That's like saying they'll pay for heart angioplasty but you have to buy your own stints. You got some bad info somewhere, me thinks. JB

[ard 0]

Thank you.

[airwayman 2]

Kindred, as you can see from these posts, all BCBSes operate independently and have their own corporate policies for morbid obesity. I live in NC, I printed out the corporate policy last year, as I had done the last three years, and "gastic banding" was labeled "investigational" which is to say it's not approved (investigational procedures are not approved). Then I heard rumblings and, in Feb, the policy was changed TO INCLUDE GASTRIC BANDING!!!! Now, this is NC....SC is literally three miles from my house and they do not approve the lap band, I was told. Another thing, the NC policy doesn't require 6 mos. of supervised diet but they do require positive proof of morbid obesity for 4 out of the last 5 years. Go figure..all BCBSes write their own policies and have their own restrictions. I can tell you that the lap band studies have been proven and many of the ins. companies are now adding it to their list of approved weight loss surgeries. Remember, the first hoop you must jump through is your company policy. If your company policy does not include WLS, it doesn't make any difference what BCBS says, it's not covered...your company didn't select that option when they bought the policy.

[Lap_dancer 8]

Kindred, as you can see from these posts, all BCBSes operate independently and have their own corporate policies for morbid obesity. I live in NC, I printed out the corporate policy last year, as I had done the last three years, and "gastic banding" was labeled "investigational" which is to say it's not approved (investigational procedures are not approved). Then I heard rumblings and, in Feb, the policy was changed TO INCLUDE GASTRIC BANDING!!!! Now, this is NC....SC is literally three miles from my house and they do not approve the lap band, I was told. Another thing, the NC policy doesn't require 6 mos. of supervised diet but they do require positive proof of morbid obesity for 4 out of the last 5 years. Go figure..all BCBSes write their own policies and have their own restrictions. I can tell you that the lap band studies have been proven and many of the ins. companies are now adding it to their list of approved weight loss surgeries. Remember, the first hoop you must jump through is your company policy. If your company policy does not include WLS, it doesn't make any difference what BCBS says, it's not covered...your company didn't select that option when they bought the policy.

They are so sneaky like that. Geez. So airwayman are you good to go?

[airwayman 2]

They are so sneaky like that. Geez. So airwayman are you good to go?

Well, let's see....I filled out ten pages of information, I've been to the required seminar, met with the psyco lady, the exercise specialist and the nutritionist. My PCP set me up for the chest X-ray, the lab drew 10 (yes 10) viles of blood for all the required blood tests. I met with the Dr's. PA, then the doctor. I met with the office manager who went over my ins. policy and expected out-of-pocket expenses. Then, let's see, I had the H. palori(?) breath test, then I went to the radiologist for a barium swallow test. All of this took...oh, two months, maybe longer. Next, I'm to call Kim the Dr's. ins. lady if I haven't heard from her by this coming Monday. She is going over my records and will talk to BCBS (she's already had an initial call w/ them) then it goes back to Dr. V, who looks over everything, if he is satisfied, it goes to Dawn, his nurse, for surgery scheduling which normally takes about a month. Before surgery I will be required to attend his pre-surgery class where they go over everything related to the surgery and give you the details of the required two week liquid diet. I'm almost there. JB