NC State employees

I have BCBS State health plan PPO.  Their policy is clear, yet confusing. It lists all the possible WLS's and then proceeds to tell you the six requirements to meet and then it says on another page oh but wait...we won't cover lap band if your BMI is over 50 and we won't cover VSG and we won't cover any 2 part surgeries. Leaves you somewhat limited...looks like my only option is RNY. Anyone had any luck getting anything approved other than RNY through state employees plan? Thanks a bunch!!

I dont work for the state, but it can't hurt to try. just keep in mind you dont have to battle the insurance company yourself, submit your paper work, see what you get back and then work with dr enochs office to get you the coverage you need. i'm sure they'd be glad to help!

They are very easy to work with but yes if your BMI if over 50 they do not cover the band. So if your BMI is over 50 they will cover the RNY or the DS. If you are between 35 - 49.9 you will have coverage for the band, RNY or the DS. Good Luck!!!!!!

VSG is what I want, which is the first part of the DS so I don't see why they wouldn't.

Right now they still consider the VSG investigational so they will not cover it alone and they only cover the DS in a one stage procedure. So as of right now they are not paying for the VSG right now. But I have heard of some dr's office having success so it's woth a try in my eyes!

Unfortunately, I had to delete this post due to privacy concerns.

Call them and talk to a customer service rep.  Get them to put whatever they tell you in writing.  I was discouraged from having lap band by my doctor so I did not have to get an OK for that.  My RNY approval went through very quickly and easily.  Now I am thinking about having reconstructive surgery and I have opened a different can of worms. 

The State Health Plan is one of the most progressive insurerers when it comes to WLS.  I had ZERO issues with insurance.  I would suggest speaking to someone at your surgeon's office about it however, every time I called the SHP, I got different answers.