Info about Blue Cross/Blue Shield of SC

Hello.....  I am new to the forum and new to the subject of lap band.  I have been to my first consult visit with my doctor and all the other visits mandatory before sending everything in to my insurance company.  I  was told by my doctor's nurse today that BCBS is hard for them to get approved!!!!!!!  I am bummed out!  Has anyone had any luck with BCBS and if so do you have any tips!?!

I had BCBS of NC and they paid 100% for the RNY gastric bypass but I don't think they covered the lapband at that time. My husband had BCBS of SC and they wouldn't cover either one, but like it has been said on here before, it all depends on what the company you have the insurance through has included in their particular policy, every company is different. Best thing to do is read your insurance manual if you have one or call the insurance company yourself and see what coverage you have. For the most part the doctors office usually knows which one will pay and which one won't. I had heard on the news a couple of weeks ago that a bill was passed in DC that insurance companies can no longer refuse to pay for weight loss surgery, but not sure what is being done with that since it is new and probably isn't in effect yet. Good luck with this and hopefully it will work out for you.
Take Care!
Mary

Thank you for the information.  I called my insurance company and asked about coverage for "Bariatric surgery due to medical necessity", which is what my doctor's office told me to ask, and it was covered 100%, BUT I did not specify which type!!!  :-(   I hope I haven't done all of this for nothing!  SURELY my doctor's offiice wouldn't have followed through if they knew for sure BCSC was not going to pay????  Are you doing well after your bypass?  Any regrets?   Thanks again!

Hopefully for you they will cover the lapband. I have had a wonderful experience with the RNY and would do it again a million times over if I had to. I have had no problems with it  and I am enjoying my life again, it's amazing how much better you feel losing the weight and all the things you can do that would have been impossible before the surgery. Just realize that everyones experience is different, just as it is with any other surgery. Yes, you will hear horror stories as well as wonderful ones, but that comes with any surgery no matter what is being done, believe me, I work in the hospital and have seen even the most common surgeries have problems, so don't go by what you hear and let it affect your decision, just do what you feel is right for you.
Good luck and take care. Keep us informed on how everything goes.

Hugs!
Mary

I had BCBS, they sent paper work on a Mon and by Wed it was approved, that was for bypass not lap band. I have heard that they will not pay for lap band, don't know if that is true or not. Best of luck to you. My advice to you is do your homework, research every detail, there is no turning back once it's done. Be absolutely sure that this is what needs to be done. I had no idea it would be this hard.

Thank you for the information......  Hopefully this will work out, I guess I will know for sure in about 3 weeks!  Sounds like you might have some regrets??  Do you? What about the surgery has been "hard" for you??  If you don't mind sharing.....

I work for BCBS of SC.  It depends on which one you have.  The contracts I handle DO NOT cover it whatsoever.  I handle small group, indivdual and SCHIP.  I do know FEP (federal dept) covers it.  Good luck on your approval.  If you're contract excludes it, no matter who and how much it is appealed, they WILL not pay!!

Thank you for the info. ( I guess....LOL)  I am not sure which contract I have..... I did call before any of my consult visits and they said "bariatric surgery" was covered 100% ???  I hope my question wasn't too general..  ???   I have this insurance through my husband's place of employment which is Michelin Tire Company - so I am sure it is a large contract.  Can I call and find this out, or do I just need to wait it out???   Sorry.... I am very insurance illiterate !!! 

My insurance is with BCBS through my husband's employer, which is also Michelin Tire.  My info was submitted to BCBS on a Thursday and I had my approval back about 24 hours later...Friday afternoon.  I have decided to go with the RNY and it will be paid at 100%, as well as any plastics after I reach my goal and maintain it roughly 6 months.  Which Michelin plant is your husband employed with...if you don't mind me asking?  MIne works for US1-Donaldson Center.

I was just telling the hubby last night that I feel quilty sometimes that it has come so easily for me, because a lot of patients of my surgeon are having a terrible time with approvals.

Good luck and I hope it works out for you.


Wanda

Oh...thank you so much for your info.  A huge weight has been lifted, I just hope it goes as smoothly for me.  My husband works at the Michelin plant in Ardmore, OK... We live in Madill, which is about 30 miles away.  If you don't mind sharing with me why have you decided to go with the RNY??

At the moment I am waiting for my test results to be sent to my insurance company, so hopefully I will know something soon.

Best of luck to you!  Thanks again!

Marcy