OUTSTANDING Move by BCBS

[Cameron_cts_sfa 0]

Just an update for everyone out there. The Blue Cross Blue Shield orginazation is beginning to fall. In the last two to three weeks three different BCBS states have begun to cover the band for there members. Colorado, New Mexico, and I want to say MS but that one might be wrong. There is hope for those who can only do this procedure when insurance covers it. Only thing they are doing is saying you have to be under a BMI of 50

[the best me 6]

Wow, hope for my sister here in NC maybe? Her BMI is under 50...we'll see!! Say, what should she do, jump through all the hoops with the Band doc, even though the Band is specifically excluded under her plan? Then appeal? Just wonderin. Thanks for the info Cameron!

[Cameron_cts_sfa 0]

Kathy I have someone attempting to use legal action on BCBC of NC right now. I'll try to keep you posted on what they do at the end of it

[sassaay 1]

Hi, I am just wondering... Did you get this info from your legal counsel?

[Marimaru 7]

I just read my own policy. I have BCBS of CA, and they cover it as well.

I didn't have insurance at the time of my banding, but I'm hoping that I can get them to cover a fill in the future if I need it

[Alexra 0]

BCBS of NJ covered mine with no problems at all. With a BMI of 53 all I had to do was have a letter of medical necessity from my Primary Care Dr. It took about 1 week to get it approved.

[bandblues 0]

That's great. I also am in NJ and had no problem getting approved. I have Horizon though.

Alexra- I was banded by Dr. Bertha in November. I really like that practice of Drs.

[Guest SarahSSW]

Hi, I'm new here and have never posted. But I wanted to let you all know that BCBS HMO of IL paid 100% of my band and gave me a referral for 4 adjustments for the first year, also covered at 100%. My BMI was under 50.

[DeLarla 22]

And my BCBS insurance does NOT cover it. But they'd pay $100,000's of thousands in other obesity-related complications like heart attacks & colon cancer. Go figure.

[Guest maxnbrickcity]

well Hello everyone.....My name is Tee and I work for Horizon bcbsnj and we have no problem in approving the lapband,but there are certain things that we need in order to approve you. first we need a diet and nutr.evaluation. two we need your eval from your psyc visit. and we also need proof that you have exhausted any and all method of trying to lose weight for 5 consecutive years. we need your start out weight,what diet,how long on the diet,weight loss if any.......this is not a lot but it must be exact.

[BCW 0]

Has anyone heard if there is any change is BCBS of Texas? The state of Texas has them write in an exclusion for anything related to WL. I don't think anyone has ever suceeded in getting them to reverse their decision.

[JulyBandster 1]

Anthem Blue Cross/Shield of CT is covering my surgery, but they did initially deny. I hired a lawyer, whom I'd highly recommend by the way, and in less than a month I was approved! My understanding with my insurance company is that they tend to deny at first, but generally will approve upon appeal. I guess they are thinking we'll go pay for it ourselves!

[Cameron_cts_sfa 0]

I got my information straight from BCBS Medical Director. I am the Bariatric Coordinator and Surgical Assistant for our office so I am on the phone with insurance companies daily.

[gina0922 0]

well Hello everyone.....My name is Tee and I work for Horizon bcbsnj and we have no problem in approving the lapband,but there are certain things that we need in order to approve you. first we need a diet and nutr.evaluation. two we need your eval from your psyc visit. and we also need proof that you have exhausted any and all method of trying to lose weight for 5 consecutive years. we need your start out weight,what diet,how long on the diet,weight loss if any.......this is not a lot but it must be exact.

Hi Tee, I have Horizan bcbsnj and I live in FL. First let me say that I have checked my policy for cover to cover and there are no exclusions to any form of weight loss surgery. The website shows 10 hospitals that have Bariatric Centers that are in network, so I'm ok with that part. What does concern me is that you mentioned that Horizon stipulates you must provide proof of any and all methods of weight loss over 5 years. I am uncertain how I am to obtain this as I have never been to Weight Watchers or Nutri Systems or any other type of weight loss system. I have tried other methods at home such as different types of diets like Lowfat, Lowcarb, OTC diet pills, exercise videos and such. My entire adult life has been involved with some type of weight loss plan. So, do you have any idea how I would get past this part? I have all or atleast many of the co-morbidities associated with being morbidly obese.

I appreciate any bit of information you would have.

Thanks,

Gina

[plump_princess 1]

I have BCBSNJ. I didn't need to prove any of that. I simply needed a letter from my primary care physician, psych eval, and a letter from the nutritionist I had been seeing, and everything went through within a weeks time. It took me a few months to get those requirements (required by my bariatric surgeon), but BCBS ok'd me, no problem. I had a BMI of about 47 at the time, and arthritis as my co-morbidity.

Good Luck to you!