Does anyone know

I have a question, I have BCBS insurance here in Texas. I called and they told me that my employer chose not to have the Lap Band cover. They told me that anything with the word "Bariatric" in it; they wouldn't cover it, but if the surgery was called "something else" that they would cover it. She told me, its all about the way its worded.She told me that each procedure has a billing code, and based on which code is chosen they may or may not cover the procedure. She also told me that, one procedure can be called multi different things based on what its being done for.  Does anyone know other wording that may be used when submitting a Lap band claim to my insurance? 

I suppose it's possible to try to slide your bariatric surgery through under another name or billing code...if you can persuade your surgeon, the hospital or surgery center, and every other medical professional involved (anesthesiologist, lab technicians, nurses, psychologist, nutritionist) to go along with it. I don't know what billing code or wording would work, though. If you have a hiatal hernia, you could could theoretically use that as your reason for surgery (since bariatric surgeons often repair hiatal hernias while doing band surgery), but surely someone at BCBS is going to wonder why a $4000 Lap-Band shows up in your records, and if they request copies of the surgeon's notes about the surgery, they're going to figure out pretty quickly that something more than hiatal hernia repair was going on. Further, they're going to wonder why your surgeon is submitting a claim every time you have fill put in your band, and should you have any complications further down the road, they'll take a dim view of paying anything for treating that complication, especially if it requries expensive surgery. So maybe the better approach would be to challenge the bariatric surgery exclusion on your policy (possibly with the help of an attorney, or persuade your employer to add bariatric surgery to your insurance coverage, or save up your pennies and/or take out a loan to pay for the surgery yourself.

An OH member who used to work in the insurance field before she retired and who does a lot of volunteer work as a patient educator gave me permission to post her contact information for people who are struggling with medical insurance coverage issues. Here it is:

[email protected]

Good luck!
Jean

Thank you so much for the info. I will contact your friend and will be thinking of asking my employer to add Lap Band insurance being that he own he own practice.

Insurance Fraud?