Arkansas BC/BS???

Can anyone tell me if they have this insurance coverage, and if so, have they every got approved for a Lapband?  I just purchased this policy and it doesnt exclude it all.  It just says written approval is needed first.  Can anyone please help me.  I am very new @ all this.  And I am wondering how I go about trying to get approved.  By the way, I mean we Just purchased this policy, because it was cheaper than my DH employer insurance and alot better.  Anyway, any help would be great. Thank YOU!

Hi! I wish I could be of some help to you but I really don't have much to offer. I am a teacher and last year at the time of my surgery, I was covered by Blue Cross. I had the top of the line policy through blue cross and they flat out denied to pay for my LapBand. I ended up paying for the surgery out of pocket. My policy had it written that they do not pay for WLS so I had no wiggle room. If yours says prior approval needed then it sounds to me like you may be lucky and it might pay for WLS. I'm sure there are several requirements that you have to meet first. I would call and talk to them to see exactly what is expected of you before they cover the surgery! Also, because you are a new policy holder, there could be a waiting period. I would just call and find out exactly what the qualifications are and what you have to do to get approved!  Sorry I couldn't help more. Let us know how you turn out!   Karen

Every BCBS is different. I had Anthem BCBS (national account).  They covered all of my RNY.  I ended up paying a total of $72 for my RNY (including $50 for a private room upgrade and $22 for a copay for god-only-knows-what).   Some BCBS will pay for WLS, but only up to $4000.  Mine didn't have that cap, so they covered pretty much the whole thing.   The first thing you need to do is ask for a copy of your policy is writing to see if there is an exclusion written in to exclude WLS. 

I have Arkansas Blue Cross Blue Shield PPO and my policy also says written approval is required. They approved me pretty quickly with one letter from Dr. Luttrell's office.

Jackie

HI, I DONT HAVE BC/BS BUT JUST WANTED TO SAY HI AND THAT I AM UR NEIGHBOR.  I LIVE IN ALMA AND HAD THE LAP BAND ON 2/11.  I HAVE A MEDICARE REPLACEMENT INSURANCE SO THEY PAID FOR ALL OF MINE EXCEPT FOR MY PART WHICH WAS 625.00.  MOST INSURANCES DO REQUIRE A WRITTEN  DOCUMENTATION FROM UR PRIMARY DOC. STATING U HAVE TRIED NUMEROUS DIETS AND FAILED .  USUALLY WITHIN THE LAST 6 MONTHS.  U ALSO HAVE MOST LIKELY WILL HAVE A PSY. EVALUATION TOO.  IF U NEED HELP HOLLER AT ME.  I HAD MY SURGERY IN LITTLEROCK WITH DR. GIBBS.    IT IS THE CLOSEST ONE TO US EXCEPT FOR TULSA.  HOWEVER,  MY INSURANCE REQUIRED THAT I GO TO A BARIATRIC CERTIFIED HOSPITAL SO THAT WAS MY CHOICE.  DR. GIBBS WAS GREAT.  IM 4 WEEKS OUT THIS TUESDAY AND HAVE LOST 19 POUNDS AND I HOPE TO GET A FILL ON TUESDAY.  I CAN EAT ANYTHING NOW CAUSE I HAVE NO  RESTRICTION  SO ITS HARD TO CONTROL MY APPETITIE.  IN FACT I HAVE CHEATED SOME.  AGAIN IF I CAN HELP JUST HOLLER.    BRENDA

Hi, and thanks so much for replying.  I am soo excited to try to get this done.  If I have any questions on who or where I will for sure pm you.  I am trying to find out what the in's and out's are of this new insurance policy.  I wish I did have medicare or medicaid it would be great.  I hope to be on the losing side soon, and again please keep me updated on your weight loss success!

I have Health Advantage which is part of BCBS and it didn't cover it.  It has an exclusion for WLS.  In case anyone doesn't know it, there is a new Weight Loss Surgery Center in Springdale at Northwest Medical Center.  The surgeon is Dr. Josh Roller.  He is very highly qualified and also did weight loss surgery at Duke University.  The whole WL Center is really great.  They have their own wing in the hospital, etc.

Hey and welcome to the board.  Ark BC/BS covers it, but it does require some documentation to be sure you qualify.  Your surgeon's office should help you get this in order.  Dr. Roller is Springdale is great.  Good luck to you.  W