BCBS Alabama

[adryan 0]

Does anyone have them? and. Has anyone here had any luck with getting them to approve the Lap-Band.

:faint:

[Ellisa 6]

Below is a quote and link from "Dustout." (I copied and pasted one of her responses, hope that's not a bad thing.) She said that the policy is not state specific (I asked on another thread). The links is very informative.

Ellisa

"I have anthem. Here is the link to their official policy:

http://www.anthem.com/medicalpolicie.../pw_034084.pdf

35-39 BMI requires 2 comorbidities.

40+ BMI does _NOT_ require any comorbidities.

I was approved a month ago one comorbidity (hypertension) although it's being easily treated with dieretic.

Good luck and check out that policy!"

[adryan 0]

I checked out that link and got really excited. So i called my provider. BUT i was tired of being on hold for long so i shot them an email. This is what it said.

"Thank you for contacting us.

Benefits are not provided for services related to the treatment of obesity, including services such as gastric bypass and related complications.

I hope this information is helpful.

Sincerely,

Kathy

Customer Service

--Original Message--

From: adryan@knology.net

Date: 10/10/2007 2:11:41 PM

To: BCBSALCustomerService@bcbsal.org

Subject: Customer Services Comments and Questions

"

SOOOOOOO yea i'm kinda disheartened right now.

[Daisalana 33]

I have BCBS of AL.

As of April this year, BCBS of AL announced they do accept lap-band now!! YAY!

However, for ME.. my insurance POLICY excludes "Any obesity treatments". So I was self-pay.

But, I found out they are paying for my fills (done in the hospital) and I pay $51 deductible. That's pretty neat. Might be an error and they'll come back and charge me later.

[Daisalana 33]

Oh, and according to my doc's office, your company excludes obesity treatment generally if they are a company of 100 employees or less. So that may give you an idea based on your company's size.

But, call your provider and ask about your company's policy. They should be able to tell you right away.

They told me "No" pretty quick

[Savedbygrace 11]

I have BCBS of Alabama and work for a company of about 35 and it is covered. Thankfully I work in the medical field and get authorizations for DME so I do know a little about how it works. I have access to pull up benefits for BCBS of AL and see that my plan does cover it. If you want, you can email me in a private message with your policy #, name and DOB and I will pull it up for you. I can go over the benefits with you via email or fax them to you.

As far as their "medical policy" they do have some requirements. Must have BMI of 40 or above for the past 3 yrs of a BMI of 35-40 with comorbs. They also required that you have documented 6 month diet, exercise and behavioral modification. There are several ways to do that. I am in month 2 of my 6 months. I hate that they control my health but I'm taking it as 6 months to prepare. Different physicians require different things before hand ... so this gives you plenty of time to get that plus go ahead and adjust to lifestyle changes.

If there is anything I can help you with.. let me know! I'm excited to get into the banded world!!

[Savedbygrace 11]

BTW.. I'm in Huntsville too! What surgeon are you planning to use?

[Daisalana 33]

Hey Wendy, I'm in Huntsville too

[adryan 0]

Dr. Mailapur. Who do you use wendy?

[Savedbygrace 11]

Hey Laura! Small world huh lol. Which surgeon did you use? I plan to use Dr. Leslie Miles in Birmingham. A little bit of a drive but I chose him because of his experience doing more bands that any other that's closer plus they give you all the info and follow up you need to make it work. We did go to Dr. Mailapur's seminar and liked him as well but he seemed to highly recommend the bypass and I don't want to do that! Do y'all go to the local monthly support groups?

[Daisalana 33]

I went to Dr. fuccundus first, did NOT like him. So I found Dr. Freeman in Anniston. It's quite a drive for me, but..

Well first, he pushes RNY. He didn't try to change my mind, but he was clear his vote is always RNY. But, beyond that he is so wonderful. Literally one of the nicest men I've ever met. I feel very safe with him. My only complaints have been the lack of fills he gave me, but it ended up my port turned around, so he's back to being wonderful lol.

I have heard a lot of good things about Dr. Miles.

And no, I don't go to support groups. The one my doctor signed me up for is in B'ham. I already drive 6 hours a month to get fills, I didn't feel like going to B'ham for groups. I heard they're 'bariatric groups' and mostly RNY patients. Not to sound snottish, because I don't mean it that way, but I think we experience different things and I didn't feel I'd benefit from it.

I haven't found a local lap-band group.. only RNY.

Do you know of a local lap-band one??? I had called around.

We should all get together I can show you guys my battle scars ;

[adryan 0]

oh wow, we'll have a lapband support group before long. lol

[Daisalana 33]

Hah, we should start one. I have random people contact me like you did adryan, from nearby..So far no one who is banded, just thinking about it.

[Savedbygrace 11]

That would be good. I know Huntsville Hospital has one but it's Bypass and Lapband so I'm sure it's mainly Bypass. They also have one at a church in Toney and it's both. Maybe we could post a thread for people close to Huntsville and see what response we get.

[kaninag 35]

HEY!! I have BCBS of AL too...I just got off the phone with them and I am kinda discouraged....my current BMI is 43 But 2-3 years ago I was able to lose enough weight and I have a documented weight that would put my BMI at 35...would this ruin my chances?? Any guesses....