Researching and need BCBS info

Hello. I am currently exploring the idea of Lap Band surgery. Before I get further involved I want to get info on getting the surgery with Blue Cross Blue Shield insurance. I am a 33 yo female with a BMI of about 46. How hard was it for you to get approved? What did they require? Any advice or warnings about the approval process? Thank you for any information you can share.

I'm afraid that I can't be much help, but I wanted to welcome you to the forum. We have a really supportive group here. There are several successful lapbanders here that I'm sure will chime in with information and support.

You might also try cross posting this question to the main, lapband and insurance boards. Sometimes casting a wider net will get you more fish to filet : )

Again, welcome and I wish you all the best in your journey to a healthier you.

Barb

BCBS just started covering the lap band not long ago... I believe last year was the first year... so not sure if we have any NC people who had it with BCBS :-) I believe with a BMI of 46 that might be too high for lapband... I am not sure with BCBS but many insurance companies limit the BMI to those with BMIs under 40 (from what Ive read)... a surgeon may try and steer you towards another surgery as well, so be prepared for that. With the RNY surgery BCBS required 5 years weight history and you had to meet their BMI requirements for at least 4 of the 5 years, I would assume it would be the same with lapband. Under a certain BMI they required you have co-morbs, over a certain BMI you did not. At the time I had surgery they didnt require any sort of pre-op diet... they did require you have a psych eval and nutritional eval... the rest of the testing was up to the surgeon preference.

I am a bandster with BCBS but I was banded 4 years ago when NOBODY covered lapband so I cannot really answer your question. I believe BCBS does cover lapband now but I really don't know how many hoops they send you through before approving it. A BMI over 40 is a good indicator (mine was 51.7 when I had my surgery) but I'm sure they look for the presence of other health issues, i.e. diabetes, high BP, knee/joint issues, etc. The insurance clerks at the WL Surgery practices would be very familiar with what BCBS requires. I know Beth at Duke Surgical Weight Loss Clinic can spout that stuff off in her sleep. So I'd start by calling one up and asking quesitions. Sorry I couldn't be more specific but I certainly wish you luck in your journey and if you have any questions about lapbands, I'd be more than happy to answer them. Starfish

From my exp w/ BCBS NC is they cover the band if your BMI is below 50 but at least 35. Since it's above 40 then you will not have to have any co-morbid conditions. They do require a 4 - 5 yr weight history. They are actually VERY EASY to work with..... Good Luck!!!!!!

I have BCBSNC.  If your BMI has been over 40 4 out of the last 5 years, then you probably qualify.  Of course, the best thing for you to do is call them (number on your ins card).  That's what I did.  Also, make sure you have all your information together before it's ever sent in.  My BMI was not 40, but I had co-morbidities and was approved first try.  BUT, I worked very long and hard getting everything together.

Thank you all for your responses and congratulations on being losers! I am going to talk to one or two of the practices that offer Lap Band at Pitt in Greenville. I'm sure they will be able to give me the BCBS scoop. What is involved in supplying a weight history? Is it getting copies of your weight off Dr's charts or is is more involved?

They are looking for a documented weight history....dr's notes, weigh****chers. They just want it documented. :)

There are many "different" BCBS plans, even w/in the state here in NC.  Just do what I did and call the benefits number on your card.  They will answer all your questions relevant to your particular policy. I do know that the surgical coordinator at my office said that BCBS was about the best when it comes to approving and paying.  But as some have noted above, your insurance, as well as your doctor, will have criteria for bands vrs. other surgeries.  I wanted the band, but because of a hiatal hernia I have AND the amount of weight I need to lose, I wasn't a good candidate and my doctor highly recommended RNY instead.  After weighing all things, I had RNY and and VERY happy with that decision! Good luck and keep us posted.

Hi there...I am currently awaiting approval from BCBS of Alabama for the Lap-Band.   I started the process back in June and it's been a long 6 months and my patience is thoroughly being tested right now.  My dr's office submitted my paperwork last Tuesday, January 8th and I confirmed at noon on Wednesday, January 9th that they had rec'd it and were processing it in review.  I have called them every day since and still the same story...it's in review.  What is so frustrating is that I have two coworkers that were approved within 48 hours for the gastric bypass within the last year.  I cannot imagine why mine is taking so much longer.   I am beginning to think that they do not approve the Lap-Band surgery as quickly as they do the GB maybe because they just started approving it within the last year and maybe because most people get the GB done. My BMI was right at 38.6 but I have high blood pressure, high cholesterol and asthma.  So my dr assured me I would have no problems being accepted. I had to submit my weight history for the last three years not five from my Primary Care Doctor.  It's my understanding that you have to have a BMI of 40 or more to be approved but you can be as low as 35 as long as you have two health problems as in the asthma and high blood pressure.   My dr also required a lot of things due to my age being over 50.  Anyway...if you know for sure you want the Lap Band then go for it.  You will have to meet the insurance's requirements but from what you've told me about your BMI...I would say you qualify no doubt. 

Good Luck.