Carefirst BCBS, don't even bother???

Nessa I called the toll free number and asked what wls does my policy cover. The woman said did I have the procedure codes? I told her no I just want to see what types of wls are covered. She insisted on me having procedure codes. She said each policy is different some have exclusions and some dont..   



                                                                                                       Julie

FEDERAL BC/BS has it's own people.  don't call the 800 number fthat's generic call the number on the back of your card.

Ok Nessa I will try again tomorrow...The 1st number was 800-638-6756...Thanks for the info..

                                                  Julie

I have Carefirst BC/BS.  I was approved.  She can call her insurance company and ask them to fax over their specific guidelines on her policy.  I did that at the beginning. 

Julie-  the doctor you are working with will give you the procedure code.   Call the office and ask for it.  Dr. K gave us the procedure code at the seminar so that we could call our insurance company and get their guidelines.

Lisa, my LapBand was approved by Carefirst BC/BS without jumping through ANY hoops!  Definitely get her to call the insurance company or talk to her HR department.  I had a list of my comorbidities (PCOS, diabetes, high blood pressure, hyperlipidemia, and arthritis) and a list of all the diets I've ever done (supervised like WW/JennyCraig/Nutrisystem AND on my own like Atkins, etc), how long I was on them, how much I lost, how much I regained, etc.  I just came very prepared since I had researched everything ahead of time.  Since it was her doctors office I HOPE they aren't doing that to try to get her to switch to RNY or another malabsorptive surgery.  Unfortunately there are plenty of docs who like to push RNY over the band because of the rapid loss related to their statistics. 

Hi sweetheart! Im sorry your Mom was told that. Every plan is different. My BCBS plan is through the Federal Govt and they paid for everything! My copay was 5.00 for the entier surgery and hospital stay. However when I first called them to see if it was covered they said "I hope its not LapBand because we wont be covering that much longer just RNY only!" and I never went into why because I wasnt getting the Lap Band. I can ask around honey. Tell your Mom to keep her chin up.
(((((Hugs))))))))

Thanks everyone! I will let you know what she finds out when she calls her insurance company herself.  I think the lap band would be the best thing for my mom. I hope she gets an answer. There's no way she could pay out-of-pocket. She said if she can't get the WLS, she would just try starving and exercising like she's tried so many times in the past. I worry about her because she has diabetes (wears an insulin pump), sleep apnea, and has had heart complications (stent put in an artery). My mom's mom died at the very young age of 60 from heart disease. I'd hate to see that happen to my mom!!

Lisa,

I'm not really educated on other weight loss surgeries other than my own (RNY), so I apologize in advance.

But wouldn't RNY be a good thing for your mom, who is diabetic?  My surgeon asked me to speak at his recent informational seminar, and I noticed during his PowerPoint presentation, the slides had been much improved and updated since I attended for my own purpose pre-op.  I noticed that he had a lot of information indicating that there were many studies proving RNY *cures* diabetes.  So wouldn't that be a good thing for your mom?

Is she opposed to RNY for a specific reason(s)?

She doesn't want something as invasive as an RNY.  I think it's the weightloss and diet changes that cure diabetes, not specifically RNY.

i think the malabsorbtion helps too.