bc bs of az ( ppo)

Does any one know the criteria or any thing " special " to get approved by them. It is for my friend. Any help will be appreciated. Thank you. Tanya

Tanya, As of January of this year; BCBS stopped covering WLS as far as I know. BCBS of California still covers it. ..... My info is based on Lap Band exclusions though so I am not certain about the Bypass (Rny)?? Your friend can call the customer service # on their insurance card and ask if WLS is covered or if there is an exclusion. I had BCBS in 2003 and it covered everything but the $200.00 hospital copay!!! It used to be the best insurance coverage of all. ....... Good luck! Joyce

Thank you Joyce, I will have me friend call her ins. Thanks again. Tanya

A related question. I am investigating bc/bs. I am already banded. Will they cover fills and related care?

Hey K.B., I wish I could give you the answer but I can only give you an educated guess based on my office experience with insurances. .... In our (Dr. Simpson's) environment with post-op care for Lap Banders, the office visit is covered by the same insurances that have approved the surgery AND some PPO's cover the visit as well if a "specialist" is allowed on your policy. The actual charge for the Fill itself is surgeon based. Dr. Simpson does not charge anything to his patients who are cash pay and only $100 per fill for those who have gone through insurance. If they have to go to the hospital and use floriscopy for the fill (because of a slipped, flipped or hard to find port) then it is much higher out of pocket. A couple of insurances cover the entire thing if it is done at the hospital (UHC, Medicare, Aetna)...... However, if someone has been banded out of country then my understasnding is that NO insurance will cover any part of the Fill!!!! I totally recommend that the Bandsters keep up on their Fills. It's so amazing to see patients melt away on a consistent basis who come in often to get their Bands adjusted!!! It makes me totally jealous! LOL! Here I sit as a post-op of almost 4 years wishing there were some type of "fill" or adjustment for my type of surgery! (sigh) Calling your personnel rep is the best way to get coverage answers. If they don't have a clue as to what you're talking about then you might want to give them some "codes" to look up which can be given to you by your surgeon. Huggggz, Joyce

I have BCBC PPO Preferred and I just had my surgery on 8/3. They're a tough cookie to crack. I was denied multiple times, I was approved in April of this year, but as an 'appeal' as opposed to as a 'new request'. I dont know if that matters. But even then I wasnt aware they had starting denying WLS altogether, my problem was they kept changing their criteria. I would call your local BCBS office and ask them. Good Luck!