New - double header, so to speak

greendragon · August 15, 2008

Hi! I'm new here, and have been considering Lapbanding for a long time. However, I figured it wasn't covered by my insurance, as BCBS of Florida (BlueChoice PPO) has a specific WL exclusion. However, I heard one of my co-workers say her friend, with the same insurance, was 100% covered, so I'm starting the ball rolling.

Both my husband and I have BMIs over 40. I'm 5'8" at 300 lbs, he's 6'4" at 480 lbs. We both have some co-morbidities (sleep apnea, joint pain, etc.)

I've just made a consultation appointment with Dr. Jawal in Ocala, FL, for Sept 5, and hoping for the best.

I know I will probably have a fight with the insurance on this. Any advice?

bamagirl386 · August 15, 2008

Hi there

I just had my lap band 7/15 w/Dr. Jawad in Ocala. U will ove the staff & Dr Jawad as well. If you stay in the hospital, it is first class treatment all the way. I will tell you that my policy is BCBS Federal PPO. Insurance paid 100%. I only had a $100.00 yes that is 1 hundred dollar co-pay. I think I have the best insurance in the world. My BMI is 36 & I have diabetes. Each policy may be slightly diff. Lissette at Dr. Jawads office will do your insurance pre-determination. I am down 19 lbs & feel great. My sugars are way down as well. I'm in Daytona Beach. Just holler if u need any info. This is a great site!

Bamagirl

*slim* · August 15, 2008

HI. My understanding is the WLS exclusion is usually based on your employer. My former employer excluded it but when they were bought out by someone else, it was included. Go figure.

Good luck.

greendragon · October 13, 2008

I just found out that I am not covered :smile2: My company, because it is a 'fully-insured' company, does not even get the option of covering bariatric surgery, according to the BCBS representative. If we were 'self-insured', we would be given that option for an expensive rider, but we don't even get that option. So even if I am considered 'medically necessary', it isn't covered. I can't self-pay, so I am out of luck. I've been here for 4 years, and don't even want to consider looking for a different job for different insurance :laugh: