Help please!!!!

[Christi 0]

Hi everyone...this is my problem...I currently have bc/bs ppo for my medical insurance. It does not cover anything Bariatric. My question is...is there anyway around that? I am morbidly obese and have MANY problems with my health:frown:. I have had a letter of recommendation from my Dr. for over a year now. Each time I contact anyone about lap-band surgery...I get the same answer...NO, it's not covered!! I was just curious if a doctor deems it a medical necessity, will the insurance pay for my surgery? Basically is there anyway around it? I desperately need help with this issue. I want to make sure there is no way to get the lap-band surgery here in the states through my insurance. I have been looking into having my surgery in Mexico, but want to make sure I have done all there is to do here in the states first. Thanks in advance for any information anyone can give me!

[StephOinAZ 0]

I also have BC/BS PPO, but the package that my employer selected covers weight loss surgery. One tip is to not ask directly if the cover lap-bad, but ask if the cover "surgery for the treatment of morbid obesity" or better yet, call the surgeon that you want to have your surgery done through, and ask their biller what insurance code they use for lap-band and then call BC/BS and just ask if they cover that exact code. Give them as little personal information as you can. They can tell you if you just give them the group number and the company name. You don't need to give them anything else, I didn't since I didn't have any other information. Try to find out if it's just your employer that excluded that option from the insurance pacakge, or if it's BC/BS just not approving it. Insurance companies are very known for denying claims multiple times before they approve them, just to see who's seriouse or not.

I really wish you the best of luck! Feel free to send me a message :cool2:

[Christi 0]

Thank you so much Stephanie. I called Dr. Malley's office and talked to the front desk a few months ago. I told her that my insurance did not cover it, and I asked her if there was anyway for them to help me push it through. She told me that if it's not covered on my plan (bariatrics) then they have nothing to go on!! I wonder if she was just trying to brush me off, who knows? I will definately look into it more. Thanks again for your help.

[StephOinAZ 0]

Well some offices will be more helpful then others, doesn't sound like yours wanted to be right now. Here are some universal codes for bariatric surgery (generalized, not specific for Lap-Band but if they cover bariatric surgery then you can most likely try for lap-band) :

These are from other bandsters:

43843

43770

These are from my BC/BS handbook w/the surgery requirements and these are specific for Lap-Band:

43773

43774

43843

43886

43887

43888

HCPCS 52082

HCPCS 52083

I know it may seem like a lot but hopefully your insurance will cover ONE of those codes, if not more. Insurance really is a pain. I see why so many people are willing to self pay, lol.

Hope this helps!

[Christi 0]

Stephanie...thank you, thank you, thank you!!! I feel so alone in all of this. It is very overwhelming to me!! I'm going to do some calling to my insurance and check things out. I will let you know what I find out. I just want to give my insurance one more shot. Thanks again for all your help!!