New Job new insurance - Care First of MD

I am a CareFirst employee, Carefirst covers most bariatric surgeries ..... there are some requirements such as a 6 month supervised diet and a physc eval. You must be consider morbid obese at least 100 lbs over your body weight. And a BMI of at least 40. Now if you have federal BCBS the 6month diet is not needed. I hope this helps. If you have any additional questions please call the number on your card or 4105813000. I didnt have any problems getting it covered and I had the Sleeve which is the one not many insurance co will pay for! There is a $1500 co-pay. I know that is not a lot because I realized I spent that on AB rollers any magic potion they sold on TV and girdles that make me look skinny and the FAD diets ! 1500  was pennies. (LOL)


Might I add Dr. Averbach is the best and his office has a great reputation with CareFirst.... It will only take about a week.

Thanks for the post. I'll gladly pay $1500 for the co-pay no problem at all. I'm going to have something called HSA PPO. My employer siad it would buy additional coverage if needed.

So does this have a 6 month diet required? If so that is what I am starting now for the next 6 months. Hopefully in February I can get approved and have the surgury there after. I actually live in VA and was just choosing Dr. Schweitzer because he is part of Johns Hopkins but someone posted that he doesn't take Care First. But someone from his office has been emailing me so maybe they do now. I want to get the VSG.

Any additional info you can give would be great. I'm starting as a contractor next week and then will be full time in January 2010 and get the benefits then.

Thanks for the help.

Oh my stats are 42 yrs old, 39 BMI, 6ft 7in tall, 345, co-morbidalities = sleep apnea, lymphodema in right leg, joint pain back pain chiropractor visits, slight hypertension, boderline diabetic.

Moeuneek1,

I looked at the CareFirst Rules and it states:

Structured diet program:

· Maryland and D.C. plan members only: must complete a structured diet program in the 2-year period that immediately precedes the request for the surgery by participation in either:

- one structured diet program for 6 consecutive months or
- two structured diet programs for 3 consecutive months. (can include commonly available diet programs such as Weigh****chers® or Jenny Craig®) and

Weight requirement:

· Maryland and D.C. plan members only: must meet eitherof the following criteria:
- BMI of 40; or
- BMI equal to or greater than 35, in combination with one or moreof the following co-morbid conditions:
hypertension;
a cardiopulmonary condition;
sleep apnea;
diabetes mellitus; or any life threatening or serious medical condition that is weight induced

· Virginia plan members only: must meet either of the above BMIcriteria or the following:
Weight at least 45.5kg (100 lbs.) above or twice ideal body weight as specified in the
Metropolitan Life Insurance Tables. (see Tables Below)

It doesen't state that VA members have to do the 6 month structured diet. I asked Schweitzers office to confirm this and they agree thats what the CareFirst policy says.

Can you confirm that since I live in VA I will not have to do the 6 month supervised diet?

Thanks.

Moeuneek1

Are you still an employee at CareFirst of MD? If so do you know the surgery codes they use for different procedures? Im finally making some headway with this and now know I would be approved for the band, but I really want the VSG or the deudoneal switch (something permanent). Can you help me?

Jack,

Just want to clarify to you that the band is intended to be permanent.  Most people have good weight loss and no problems, but like all of the surgeries, each one has statistics both in success stories and complications.  The band's adjustability allows continued weight loss after the honeymoon period and does not require removal or rearrangement of any of your organs. Personally, those are the two things I like about it.  But there are people who do not lose enough weight for their satisfaction and those who have some problems.  Whatever surgery you decide is completely up to you and your surgeon.  There are people who've succeeded and failed with all of them, people who will tell you theirs is the only right one, etc.  Just be comfortable that you've thoroughly researched all of your options and are confident with your decision. 

Best wishes for your goals.

Terri