BC/BS of California approval for VBG

Hello Everyon, Just a quick question, has anyone had difficulty getting approval for the VBG from Blue Cross, I called my doctors office today and they are getting conflicting information, one rep said procedure is not covered and we could not appeal and another said procedure is covered. Thanks Nia

It may not be the same thing, but I had BCBS Federal and there was no problem with approval. They do not cover lapband, but they did cover VBG. They would not pre-approve the procedure but they approve the hospital admission. As long as it's medically necesarry and you meet their guidelines (for me it was 100 pds. or more overweight) Check your plan coverage booklet and see what it says. When I initially called the customer service they didn't even understand what I was asking about when I said Bariatric surgery so I would get the VBG procedure code and call back again. Another person I know with BCBS Federal saw the Dr. on 12/14 and had surgery 12/27. I never had to deal with BC and was out less than $500 total for my surgery. I have PPO. I hope this helps...good luck!!!

Thanks Natalie, this helps a lot. Gives me hope that I will get approval, I did try to get approval for lap band but they denied it and my appeal. Thanks for the info, I'll keep my fingers crossed. Nia

Nia- I hope this all works out for you. I was told lap band was not covered because BCBS considers it experimental. Keep us updated, okay? Good luck!

Well, I just found out I was denied although not officially. BC/BS said I have a specific exclusion in my plan that does not cover the surgery. I contacted my HR department for copy of my plan. Basically it states that obesity treatment (I'm assuming diet pills, weigh****chers and the like) is not covered. Surgery for the morbidly obese is covered if it is medically necessary. If they had taken the time to review their own documents correctly, they would not have given me the run around. I forwarded all this information my doctor's office and they will re-submit this to my insurance. Hopefully I will get a better outcome next time, wish me luck. Nia

Nia- This is good news! My BCBS plan is the same...it will not cover drugs either, but covers the VBG and RNY if medically necessary. My surgeon's office was very familiar with my insurance and I did absolutely nothing to get approved. I consider myself VERY lucky after reading so many other people's struggles to get approved. Please let us all know how it goes. Good Luck!! Natalie 281/209/125

Thanks Natalie. I will let you know my outcome. Nia