Insurance

Has anyone out there had BCBS Federal insurance with the Lap Band?  Any information or tips would be so... helpful.  I am going for my consultation Monday the 14th of July.  Just wondering if anyone had any problems with this insurance or waiting period.  Thanks!

I had Federal BC/BS cover my VSG with Dr. Nelson of OWLO! It is GREAT coverage! They cover WLS without any predetermination necessary. If you meet the NIH (National Institute of Health) criteria for WLS, you're covered.

The criteria is a BMI of 40 or greater, or a BMI of 35 or > with 2 qualifying comorbidities. Their qualifying comorbidities are diabetes, dyslipidemia, hypertension, and a few others. They covered ALL of my hospital bill except for my $100 co-pay. I had co-pay amounts for most of the other services, but all were more than acceptable in my opinion. 

Fed BCBS covers  RNY,  Band, or  Gastric Sleeve. We love our Fed BCBS insurance!

Oh, I forgot to mention that you should check to see if your surgeon is contracted as a preferred provider with BC/BS Federal. If not, it means he doesn't accept their payment prices for services and you will owe more than I stated above.

If he's contracted with them, he will be listed as a preferred provider on the Fed BC/BS website at http://www.fepblue.org . If not, you will need to ask his insurance people what their fees are and how much you will be left owing after your insurance pays.

Not all surgeons or physicians sign insurance contracts because the insurance companies set limits on what prices the surgeons can charge for their services. If the surgeon signs the contract, he cannot charge you above what the insurance company allows in the contract. They get more patients by being contracted with insurance companies, but they are limited to the insurance company's allowances as to what they can charge.

Good Luck and Welcome to the OK board! : )

Thanks Shelly, you are very helpful.  Looks like you are doing very well.  Hope i do as well.  Very scary not knowing everything. Were you afraid before your surgery?  I am so afraid of failing.  Is the pre diet and the diet after that hard to do?  just can't imagine not eating for that length of time.  My dieting skills are not very good.  Guess thats why I am where I am today.  Thanks again. Sue

Well, all the surgeons have different diet plans and I'm not familiar with Dr. Gornichec's diet requirements. I only had to do a 10 day pre-op diet. It wasn't too bad for only 10 days, but some require a 5 - 10% loss of body weight prior to surgery. My surgeon makes that determination on a patient by patient basis.

Post op, I'm not feeling bad about diet at all. I also exercise more than ever before. I'm really not hungry and really have to push myself to eat my minimum daily calorie requirement. I don't have a LapBand, but several of our other members do. I think our diets are similar post op, except LapBand gets to progress through the diet much faster than VSG or RNY.

I'm really happy I had my surgery. I bet you'll be just as happy.

The pre-op is truely the hardest part of the entire journey.  Afterwards, is a walk in the park compared the being head hungery. Good Luck

Anyone out there that has had the Lap Band with BCBS Federal?  We sorta think we may have run into a snag.  They only keep you 23 hours.  The insurance says that it is out patient  anything under 24 hours and it will cost out of pocket 15%.   One more hour and its only $100.00 co pay.  Anyone have this problem with them?