Insurance Coverage

[TTW85 0]

Hi! i am 6 foot 305 lbs. i am looking into getting the band surgery done. I am applying for Blue Cross Blue Shield. does anyone know if BCBS will cover the lab band surgery? Please let me know

[*slim* 2]

I am scheduled to have my surgery through BCBSIL this week. It really depends on your policy. Even though they cover it, it depends on your employer. Some employers have specific exclusions for WLS. The easiest way to find out is to call the number on the back of your insurance card and ask for a paper copy of what is covered for WLS. You also want to find out what the requirements are for them to cover it if they do. If you are just applying for the policy, ask them if there is an exclusion for that in the policy. I hope this helps!

Edited September 23, 2008 by *slim*

[DanaM 0]

I have BCBS of Alabama and it does not cover it BUT my husband has BCBS of Alabama and his does cover it. I payed $50.00 co-pay and it covered the rest.

[Mr. Green 3]

One thing I found helpful was going to my insurance carrier website and downloading and printing the entire WLS policy. A little confusing in some parts, but it gave a good picture of what was covered and requirments.

[kymmie 0]

I have BCBS Federal Employee Program, and it was covered.

[TQUAD64 9]

I have CALPERS BC/BS Net Value...It does cover lap-band and gastriac bypass, but there are many many many requirements I must meet before I can have the surgery. I am very close to being done and I hope to have surgery in November.

Good luck! :confused:

[msavoy4901 0]

Has anyone ever heard of an insurance company not having to pre certify their surgery? my insurance company is insistent that they just look at it when the bill comes in and as long as I meet the requirments. Im nervous about this but just wanted to see if anyone else had the same thing.

[illinoishusker 0]

Mine was covered under BCBS IL, but it depends on what the employer will cover.

[Mr. Green 3]

Has anyone ever heard of an insurance company not having to pre certify their surgery? my insurance company is insistent that they just look at it when the bill comes in and as long as I meet the requirments. Im nervous about this but just wanted to see if anyone else had the same thing.

Have you insurance company put that in writing. Also, have them send you a copy of the policy which all companies should have one.

[nazzy 1]

i have bcbs michigan i live louisana tho im 100 percent covered on surgery,i had to do a 6 month diet u cant skip a month and u have to make sure its a true 6 months,i went every month but feb and in july my dr had me just weigh in on 1 of them,they asked for my charts sent,then the lap band place said my dr said it was medical nessicry for me to have it.so i have a date oct 20th,i do tests oct3 and if all stays well ill have my band.it was alot of stuff to do but will be worth it come this nxt summer when im looking good.gl to all,one other thing bcbs michigan doesnt cover the dr weight diet i had to pay almost 100 a month for it,just so u know and dr best chart everything u is doing,good luck

[Gary Smithey 0]

I'm a health insurance agent in Texas. I would be shocked if any individual plan covered weight loss surgery. But it appears that any group plan that wishes to allow it, can choose to do so and pay for it.

It's possible that some states might require them to, but I would be surprised if that's so. If providing competitive benefits is what the company is trying to do, it would only make sense to provide weight loss surgery.

As to do it now and submit it later plan, WOW! That's a true leap of faith.

In my own case a very experienced local drs. staff told me two years in a row that they called and checked and that my policy didn't cover it (and I have Blue Cross). I accepted their "expertise" as being unimpeachable and let it go. Not long after the 2nd turn down by the drs. office, who stated I just didn't have the benefit, I had to discuss something in my plan with Blue Cross of California (now Anthem) and I asked them, not thinking I'd get a positive response, if they would cover it.

YES, they said, if it was a medical necessity. (This was in the same year, just two months after the 2nd turn down).

I did what they asked, I jumped all the hurdles, and surgery is 10/3. So don't even trust your drs. office to get it all right. Call them yourself and ask them lots of questions. You are the one who will gain if like, me, you get a different answer. 3rd time was a charm.

And if your company doesn't have it this year, they just might add it next year. Talk to your head of HR if you can and ask if they are considering adding it in the future to their plan.