Blue cross blue shield probs?

Hey everyone, I'm new to the boards, so I'll introduce myself- My name is Rebecca, I'm 21 years old, and hoping to get the lap band surgery. I just attended a seminar in Concord on Jan. 18th, and they made a comment there about Blue Cross Blue shield being a little slow to accept the lap band, and that they seemed difficult to get approval for the procedure. I was wondering if anyone else has had difficulty getting approval for the procedure through them, and if so, can you offer any suggestion to me before I file my claim? Has anyone had to file an appeal with them? I have my consultation visit scheduled with Dr. Bauman on the 22nd of Feb, and I guess I'll learn more there, but I just want to be as prepared as possible. I'll be crushed if I don't get approved! Any suggestions are greatly appreciated! :bow:

Have you considered the RNY gastric by pass. I have heard most insurance companys do pay for it quickly. RNY has a much better success rate , although some folks are scared of it , I think for most of us it is a better choice. NOW of course I have heard some that do the band with great results BUT much less than the RNY. Also with the band you have fill ins to worry about. As young as you are , you should be a fine with a rny type. Good luck and whatever you decide , keep on the insurance company Dont allow them to hold you back. I myself am a self pay, I refused to take no for a answer. Take care

Thanks for the reply, but I know lap-band is best for me. I've researched it for months! My BMI is only 39.9 so I feel that RNY would be too drastic. Also, I want to have children at some point in my life, and I think lap-band would be the better choice in that case. If my insurance won't pay, then I plan on appealing for sure. and if they STILL won't pay, then I'll just have to pay for it myself. I'm not taking no for an answer either! lol However, if I have to pay for it myself, then that will require a few years of me saving every penny I've got for it, and I would hate to have to put off the surgery for that long!! I would absolutely be crushed. :-( :-( Did you have BCBS?

Just a reminder that you can still have children after either procedure.

Hello Rebecca, From my exp BCBS NC currently doesn't cover the band on the first submittal. Normally you have to get to the 2nd level appeal outside of the insurance company. Sometimes if the band is the best way for you then the way your surgeon words the letter will sometimes get you the approval. There are not many bandsters on this board...you can go to www.band2gether.net and get a wealth of info. Great support and fun. We meet once a month and would love to have you. I have lost over a 100 pounds w/ my band. I love it. It isn't right for everyone that is for sure. My dh supported me w/ it and I needed his support. We were both a little scared of the RNY. Personal choice. Good Luck!!!!1

BCBS doesnt cover lapband. I know they are considering it and you may want to email the NCDOI and find out if they can give you more information. They are a good resource and can offer you advice and help when it comes to the insurance companies. There is somebody on here who had them cover it but, I believe, they got a lawyer. As somebody stated you will have to go to the external review. Everybodies plan is different and doesnt have an external review so you may want to check what your appeals process is. I had to file 3 appeals with BCBS to cover my WLS but was finally approved on the 3rd go around good luck to you!

HI Rebbeca, I had RNY last week but I did look into the band at first but Blue Cross Blue Shield said they didnt cover it and the more I looked into RNY I knew that was the best choice for me. My sister has the band and is doing very well with it but you do lose at a slower pace then with RNY. I am only one week out from surgery but doing pretty good now, it seems to get better with every passing day so if they dont cover you for the band try looking into RNY, Im sure you will do great. But if you really want the band you will have to fight tooth and nail with the insurance co. they gave me a real hard time and even denied me for the RNY so I had to appeal and then get an appeal from my sugeons office and after awhile I was approved. Just dont give up and fight for what you want. Good Luck and God Bless Denise

from what i have been told insurance in north carolina is not coverin the band due to them still havin it listed as a cosmetic surgery best of luck with it though

Hello Rebecca, You need to know a few things. 1. BCBS DOES cover the lapband. But you have a fight on your hands. 2. I got denied, twice, got an atty, fought like hell, and they covered my band. 3. I know EXACTLY what you mean not being comfortable with RNY. I dont offer suggestions on which surgery anyone should have. But you will find MANY who do. 4. You WILL have to fight for your band. 5. You CAN lose weight. Slower pace, true,, but that peace of mind you are looking for, will be there.. 6. I had my first fill last Tuesday,, it took 45 seconds. No pain, no discomfort ****ch this board,, although very helpful, it can skew your views. So many "comments" are made on here, and they are NOT fair, nor indicative of what you know is best for you. Read my profile, and contact me if you would like. Steve

Rebecca, I am not trying to make you change your mind about lap banding..but let me share my experience with you...I had lap banding in 1997 under a study in Greenville nc...I weighed 280 pounds...I left that surgery feeling no different than before the surgery...meaning that I never felt any fuller than before the surgery....I could not tell I had anything done...they increased the saline "pumped me up" so to speak and then I felt choking....from 1997 to 2005 I went from 280 to 269...the last few years I threw up everyday...I choked had horrible acid reflux...ended up with lots of ulcers..it nearly drove me insane...I did eat slow....I did avoid foods that made me choke...but honestly it was random and one day I could eat salad the next I couldnt...one day I could eat chicken the next I couldnt...I would have to stop the car to throw up on the side of the road all the time..I could never enjoy going out to eat, because everyone was sure I would be sick and leave the table and it almost always happened...saying this caused a little inconvenience is an understatement...it ruined my life for many years...my surgeon was not supportive and everytime I would explain to him that I was choking and throwing up and not losing any weight he would say ...well eat the things that hurt you and you won't eat...Of course you eat things that dont hurt you it is natural to migrate towards those things...what were they???? Ice cream.....mashed potatoes....lots of carbs...etc...I finally went back to this surgeon to get this thing out of me and he admitted to me that the study was a disaster...that is why insurance does not pay for it...not only did it not work for me it did not work for anyone in the study..it caused major problems with vomiting and choking...and little weight loss..I decided to have gastric bypass since they had to remove this band anyway...Rebecca, I am here to tell you that my life has drastically changed...For the first time in my life I know what it feels like to be full....My cravings for carbs....candy etc has disappeared and I am finally living for the first time in 20 years....I never felt full with the lap band I just choked....The difference is night and day,....My recover from gastric laproscopic was much easier than with the lap band, because of a infection where the port was put in...I went from 269 to 149 in 13 months...Mine is just one story and I know you have your heart set on this...but think of this.....The surgery is less expensive than Gastric Bypass.....why do you think the insurance company wouldn't pu****if it were successful??? It would save them thousands of dollars..wouldn't it...? Please research a little more...ask to see the study that was done on this surgery...What ever your decision I wish you the best of luck and email me if you want additional information.. Kimberly