BC/BS IL --- new rant

KayleighsMommy · June 18, 2008

I am not banded but working on it. We have BCBS through the Carpenters Union. I contacted the union office 2 weeks ago and asked them if the Lap Band was covered. The rep said yes, I need a letter sent from my doctor to the union which they turn the file over to Magellan Health Services, a third party, then they approve or deny. I asked if it's approved what next? I was informed that I would receive a letter and then schedule my surgery with the surgeon. WOW that was easy!
Called again yesterday to ask a question and was told by a different rep that Lap Band is not covered only Bypass. Don't know what to do now.

Where are you having the surgery for $5500.00?

I'm sorry you are going through "insurance Hell" been there, done that. My best advice would be to go see a surgeon (BC/BS should pay for that, at least :smile2: and let them send in the preauthorization request.

I am glad BC/BS of IL is not the only insurance who hires reps who don't know their butts from a hole in the ground (just a little bit bitter here) It's crazy you can call 5 times in a row, and get 5 different interpratations of your policy.

I actually am having a hernia repaired, the $5500 is my portion of the lapband I am going to have done at the same time. I guess I consider myself "fortunate" to have this hernia...otherwise the self pay would be 9K. There are a couple of surgeons here in CO who do it for that (mine being one of them) My dh would NEVER go for paying 9 grand, but understands I need surgery for the hernia anyway, and that I don't want to go through general anesthesia/multiple surgeries if I don't have to.

Please keep me apprised of how things are going with you.

julie

nazzy · June 18, 2008

i know i was all confused on what to get exc..im lucky my pyscho test is covered if not that was 200.i payed 73 for . nutrinest she says i can send bill into bcbs they probley pay me back.see the lap band dr i pay office visit and they cant seem to tell me how much a percent they say.lol.then 400 cash out of pocket fpr ex the insurance isnt gonna cover fpr surgery.trying to get answers is the hardest part,i booked ahead all my appts,so after i see dr 26 june i have test july1 on 3rd other 2 things then im set i think,lmk