My Brother and Insurance Question???

Hey everybody, My brother has Anthem Blue Cross and Blue Shield.  He went to see Dr. Dyas about WLS, probably lapband and the insurance person said his policy has the "clause" that doesn't cover ANY weight loss surgery.  She said she couldn't help him at all.  I told him I would check the board to see what is up!  His BMI is 49...he was just diagnosed with Type II Diabetes...his A1C was 12!!! Mine never went over 8 when my sugars were constantly running in upper 200's andlower 300's.  He has high blood pressure and I suspect sleep apnea...he has to sleep in a recliner. Does anyone have any info on Anthem BC.BS and can the "clause" be fought due to the medical issues!!  He weighed 373 when he was first diagnosed and has lost down to 340 something.  He REALLY need WLS...he is 50 years old and we lost our dad at the age of 44 from heart attack!!! Hoping you can help!!!

Hey! I don't know anyone that has that type of BCBS however I have heard of lapband not being covered. Maybe he misunderstood??  I would call the insurance company.  I am praying for him!! 

No, the clause was for any kind of wls or weight reduction programs.... Thanks for the prayers.  

Hi Connie! Anthem owns 13 BCBS plans across the country, and within each of those states is a various number of different insurance plans, many of which are customized for the particular employer group it's sold to. Whoever he works for most likely has an option to purchase a "WLS rider" which would provide coverage for the surgery, however it is fairly expensive so many group don't purchase it. If the employer group doesn't purchase that rider, there is probably a clause in his policy saying anything and everything related to WLS is excluded from coverage. I know I've thrown in a lot of 'probablys' but I hope at least some of this has helped.   I would have him contact his HR department to verify the exclusion and see if there are any other provisions for him. 

Thank you Phyllis!! I will pass this information on to him. Have a wonderful week!!