Lap band procedure not covered...

Someone from the lap-band board provided the CPT code for the procedure and also a diagnosis code (which I don't know what it is). I called my INS and the woman said that procedure isn't covered under my policy. Does anyone have any experience with being told it's not a covered procedure, but ending up having insurance cover it? I've been doing alot of research and really want the band. My mom was banded in February and is doing really well with it. Interestingly enough, we have the same insurance plan but different employers, but both fall under the "public sector" group with Anthem BCBS of CT since my dad is a police officer and my DH is a firefighter. Hers was covered but she also cannot have the RNY, so maybe that is why? I'm just incredibly sad by what the woman said, I was really hoping and praying that it was covered. I haven't even met with the surgeon yet and now I don't even know if it's worth going through all the hoops knowing that it probably won't be approved. I cannot afford to self pay, not at this point anyway. $15k is not just laying around. Any advice or experience you might have would be great. I'm quite bummed... for everything else our insurance is excellent- I didn't pay a dime when my son was born and spent 10 days in the NICU at Bridgeport hospital, I was also on hospital bed rest for 10 days prior and they covered it 100%. Our prescription coverage is good, low copay compared to alot of other plans. Why won't they consider Lap Band? I am not really considering RNY, the thought of cutting my insides and re-routing them scares the heck out of me. Long-term, after doing much research I really think that Lap band is the way for me. I have heard too that BCBS considers the lap band procedure "experimental" but they allow the RNY. That just doesn't make sense to me. Any experience with this is appreciated. I posted over here on the CT board too thinking that maybe, just maybe, someone else has the same type of plan. I know that every policy is different and each has their own exclusions. It just all stinks! Thanks everyone, Lisa

Hi Lisa, I just wanted to post something to you quickly regarding my experience. I was denied for the lap band as well through BC/BS Anthem. I wrote what I felt what an awesome appeal letter and the decision was overturned! It seems that a computer is actually the one who denies these procedures not even a real person (I heard this from an employee!) so having an actual person (or panel) review the paperwork is often all that it takes. I opted after all of that to have the bypass instead for a variety of reasons. I would be more than happy to share other info with you and any help that I can provide. Email me and we can talk about it. Don't give up! It will all work out! Nicki

Hi Lisa: Did I send you the info about Roberta A? Towanda

Hi Lisa, Athem bc/cs will not cover the lap band because they feel that it is still experimental and the fills are not covered and they cost $300.00 everytime you need one. I really think you will be happier with the gastric bypass surgery. My friend had the lap band in sept of 04 she lost about 60 lbs and gained it all back. I think the lap band allows you to be more noncompliant than the gastric bypass. I had the gastric bypass in Jan of this year and I am so pleased that I chose that route instead of lap band. I've lost 70 lbs and have 10 more to go to goal. Think about it and research it and go to the support group meetings at middlesex hospital where you will meet a great bunch of people that can answer just about any questions you have. Good luck on your journey. email me if you'd like. Cindy