Does BCBS cover fills?

[bsimoes 0]

I had my surgery on June 18th, and I will be going to the doctor's office on the 31st of July for a possible first fill. I was just wondering if this is covered or should I expect a big bill? thanks.

[princess_n_thep 2]

Mine does for blind sticks (and I even got my band in Mexico). But they make me pay first then fill out the paperwork, submit and wait for the money (minus a minimal copay). I am not a fan of blind sticks so I prefer to return to TJ for my fills under flouro. Actually costs less.

P.S. Mine is BCBS of Arizona. States differ.

[Alexandra 55]

If your insurer covers the procedure, they absolutely should cover at least a few adjustments, or adjustments for a period of time. In paying for the surgery, they have agreed to cover the treatment for a medical condition. Without at least a few adjustments, the band is not a complete treatment and as such is not therapeutic for the condition.

If you have an adjustment declined, APPEAL. The insurance industry is still adjusting (no pun intended) its policies as the band gains in popularity, and this is an area where we all can help. Have your doctor write a letter--which he probably has written before--stating that the adjustments are a critical part of the treatment.

Bottom line: Adjustable gastric banding is not complete without adjustments, and they should absolutely be covered!

[wendy645 1]

Mine does for blind sticks (and I even got my band in Mexico). But they make me pay first then fill out the paperwork, submit and wait for the money (minus a minimal copay). I am not a fan of blind sticks so I prefer to return to TJ for my fills under flouro. Actually costs less.

P.S. Mine is BCBS of Arizona. States differ.

You got it done in Mexico.... so BC/BS AZ will cover fills but not the procedure?

[Sofia 0]

If your insurer covers the procedure, they absolutely should cover at least a few adjustments, or adjustments for a period of time. In paying for the surgery, they have agreed to cover the treatment for a medical condition. Without at least a few adjustments, the band is not a complete treatment and as such is not therapeutic for the condition.

If you have an adjustment declined, APPEAL. The insurance industry is still adjusting (no pun intended) its policies as the band gains in popularity, and this is an area where we all can help. Have your doctor write a letter--which he probably has written before--stating that the adjustments are a critical part of the treatment.

Bottom line: Adjustable gastric banding is not complete without adjustments, and they should absolutely be covered!

My policy has an exclusion so I self paid my band in Costa Rica, but want to have my fills here in Houston, call the insurance and they told me they might covered with a predetermation (?) note from the doctor, they said it depends how the doctor put it can be covered not as a WL plan or procedure. Any experience ? what the letter have to say then?! :help:

Blessings

[TracyinKS 7]

My band was covered by BCBS and my fills are a $20.00 copay.

[wen 1]

I have BCBS Federal. All follow up, including fills, is completely covered for the six months for me.

[bsimoes 0]

Thanks everybody, Blue Cross covers fills for the first three months after surgery. In that time I will have had two fills. My first was 1 cc and the second will be on the 24th of September and my doctor said that he would put in 1/2cc. I hope that helps because I just feel like there is really no restriction. I can eat bread, Pasta, pineapple etc.--all the things that people with restriction might have trouble with. I love those things, so I'm not complaining...I just want to be full sooner and with eating less than I am. Thanks for all of the replies. It's so funny how it is handled so differently insurance company to insurance company. I'm hoping that they soon come to their senses and just cover them regardless of the timetable.

[Alexandra 55]

My policy has an exclusion so I self paid my band in Costa Rica, but want to have my fills here in Houston, call the insurance and they told me they might covered with a predetermation (?) note from the doctor, they said it depends how the doctor put it can be covered not as a WL plan or procedure. Any experience ? what the letter have to say then?! :help:

Blessings

This pretty much depends on exactly how the procedure is coded. The procedure itself is a hypodermic saline injection, with or without radiology at the same time. That procedure is common and not excluded just on its own merits. But the problem will be the diagnosis code--I don't think your doctor would be able to label it as anything other than a lap-band adjustment without committing outright fraud.

[Sofia 0]

This pretty much depends on exactly how the procedure is coded. The procedure itself is a hypodermic saline injection, with or without radiology at the same time. That procedure is common and not excluded just on its own merits. But the problem will be the diagnosis code--I don't think your doctor would be able to label it as anything other than a lap-band adjustment without committing outright fraud.

Thank you so much for your help!... I was hoping a way to save some money because as a selfpay is hard to keep up with the fillings... Again thank you for the information...

Blessings