Anyone here have info on BCBSMA?

Hi Everyone,   I live in Elkhart and I want to have the Lap Band. I just got insurance thru my job on June 1st. its Blue Cross / Blue Shield of Mass, the PPO plan.

Since I am just recently covered, I havent gotten any of my info in the mail yet, like the book that details whats covered, my insurance card, member number, group number, etc. As soon as I get my card & other info in the mail, I will make an appointment with Denise Murphy's office ( Team Bariatrics in Goshen, Indiana ) and start the process, but until then, I was wondering if anyone else here has the same insurance plan as I do, and if so, what has your experience with them been? do they require any type of 12 month or 18 month dr supervised diets, etc?? ( I dont have any more than about a week of a physician supervised liquid diet ) ANY info you could give me on them would be VERY helpful!! Thanks!! Elizabeth

Elizabeth, I have Anthem BCBS and since the company that the insurance is through (ie, I work for Lilly's) dictates what it wants the insurance to include, all Anthem BCBS plans aren't created equally. When you get your card (don't hold your breath on a book...I've been with BCBS for 3 years and no book yet) call the number on the back and ask them to send you the policy guidelines regarding weight loss surgery. You may want to also ask them to send a copy of any required documentation that needs to be included in your approval package. As to the physician supervised diet, in June of 2006, it became an Indiana state law that no insurance companies are allowed to require more than 6 months of physician supervised dieting. While you are on the phone with BCBS, ask them what their policy states. Most are 6 months but occationally, we hear about a 3 month or less. Also, ask them what is required with that (frequency of office visits, etc). Best wishes! Sherri

Sherri,   First of all, THANK YOU for taking the time to reply.. it means alot!!  :)

Second, you gave some very good advice. I DO have the number for Member Services, so I will have to give them a call. I did look up their GENERAL policy on obesity surgery, including Lap Band, and it is covered, however I havent seen my actual EMPLOYERS coverage yet; the good news is that I did find info on this site from someone who is emplyed by the exact same company as I am and who has the exact same insurance, and they were approved after the 1st letter.. this doesnt prove anything about any sort of diet history, but what it does prove is that the company DOESNT have any exclusions written into the policy. ( or, I should say, it didnt have any exclusions at the time that other person had her surgery! ) The GENERAL policy ( available on their website ) states the requirements are:  "Adults who are over age 18...who are morbidly obese are eligible for obesity surgery if all of the the following criteria are met: *The Physician has indicated that the patient:     1) Is a well informed and motivated patient with acceptable operative risks     2) A strong desire for substantial weight loss     3) Failure of other non-surgical approaches to long term weight loss     4) The patient is enrolled in a program which provides pre-op and post-op multidisciplinary evaluation and care, including behavioral health, nutrition, and medical management."     5) BMI of 40 or above, or 35 w/ 1 or more co-morbid conditions So, the way I look at it, no matter how I slice it, I will be approved one way or the other. I SURELY qualify for all of the above and DO have medical records to prove how long I have been overweight, the ups and downs in my weight, discussions of diets and exercise w/ at least 1 doctor, etc... so even if they say I need 6 mos of nutritional counseling, so be it.. I will do it and then get a Lap Band for a Christmas Present!!! ( That is AWESOME news about the indiana law saying that diet /nutrition requirements be no longer than 6 months!! ) I really appreciate the info you gave me... I am going to  schedule a consult w/ the surgeon ASAP, so if needed, I can start the Phys supervised diet / nutrition counseling right away and hopefully be DONE with it by December! Thanks Again...............  :) Elizabeth