BC/BS HMO Small Group - Texas

TxChick50 · January 10, 2007

I was told by my insurance agent (broker) that BC/BS HMO Small Groups would not cover lap banding. In my benefits book under exclusions is the line, " Any treatment, drug, procedure etc. for weight control/ obesity...

is not covered".

Has anyone on a small group plan ( 50 employees or less) been covered in Texas?

Candle · January 11, 2007

I also have a small group plan through Anthem BC/BS in CT.

I was told by BC/BS direct that they cover the Lap-Band but my employer excludes it on my specific policy. My employer knows nothing about this exclusion and told me to call our broker. Our broker indicated that with small group plans “commercial plans?” the Lap-Band is not covered. My coverage was just changed from HMO to PPO as I no longer live in CT.

I contacted an attorney that posts on this forum, Gary Viscio, to find out if it’s even worth it try and fight BC/BS.

I’ll update if I find anything out.

TexasBr@t · January 11, 2007

I have a small group plan too BC. BS and i tried for 2 years to get it covered and they would'nt do it even tho i got them all the info that they told me that they would need they still did not cover it. So i went and got all this info for them for them to still tell me NO NO NO .. well after 2 years of trying. I gave up and went the self pay route. And i am so happy i did. Yall keep up the fight.

kjangraw · January 11, 2007

I am with a small BC/BS group in NH and it is covered. When I started the HR person told me that it was one of the better plans. I thought she was trying to lesson the pain of the 100 per week I pay for it. I also work for a family business so the owner opted for everything on the plan as his wife, son, and DIL all work here too. Pure luck.

TxChick50 · January 11, 2007

OMG! I'm scheduled for surgery tomorrow. I am SO ready for this to happen. I called BC/BS this am and was told that my policy excludes coverage for obesity treatment.......However, the CPT code for lap band is not specifically listed in exclusions... Now what do I do??? The customer service rep told me that I could get my doctor to write a letter and go thru the denial/appeal process! Don't know if I could stand to go thru months of that and then be denied. I have been planning on self-pay all along but $15,000 is a lot of money.

I AM the plan administrator for our plan. When we signed up with BC/BS HMO, wasn't asked any questions about this sort of coverage. (Small family owned company with only 3 employees.)

I think I have just talked myself into going ahead with surgery tomorrow. I don't think I can go thru with the process. Especially after being on Clear liquids for a week!! LOL