My BCBS covers..

[famouslastwords 0]

My insurance policy covers one weight loss surgery, but not the Lapband, it covers the Gastric Bypass, does that mean I will not be able to have them pay, or is that worthy of appeal, and what would be my first steps towards appeal?

[christellini 0]

I have Blue Cross and when I contacted my insurance I was told that LapBand wasn't covered but that some people get it approved anyway and that I can still attend a consult. I couldn't believe they would explain it that way. I hung up still not sure so I'm going to see what the surgeon's staff has to say about it when I go in for consult.

[Alexandra 55]

My insurance policy covers one weight loss surgery, but not the Lapband, it covers the Gastric Bypass, does that mean I will not be able to have them pay, or is that worthy of appeal, and what would be my first steps towards appeal?

Blue Cross is different from state to state, and each state has its own rules about appeals. In New Jersey, my surgery was denied by a different carrier for the same reason; they said banding was experimental. I was able to appeal it and it was overturned, and my surgery was covered.

Find out exactly what your policy says. Check with other people IN YOUR STATE who have BCBS coverage. Find out what your state's policies are on appeals and challenges to HMO decisions. There is no good medical reason to exclude gastric banding if other bariatric surgeries are covered, and the people regulating health insurers in your state probably agree. Check it out, and good luck!!