Blue Cross

.  Who has it and what do they cover?

BCBS OF AL WILL COVER RNY AND VERTICAL GASTRIC BANIDNG BUT NOTHING ELSE.  THE MD IS COVERED IF HE IS A  PREFERRED PROVIDER AND 1/2 OF THE HOSPITAL COSTS. THEY CLAIM THAT LAP BAND DOES NOT MEET THEIR MEDICAL CRITERIA. EVEN THOUGH THE FDA APPROVED IT. I WAS TOLD THAT ONE THING DOESN'T MEAN THE OTHER

BC/BS FEP standard option covers, and this is her words..."gastric bypass but not lapband.   She did not give me a reason but I am thinking it does not meet their criteria.   I am just starting the process so we will see.   Standard also covers 90% of hospital with $100 deductible at time of admission.   Surgeon is covered with just a co-pay of $15 each visit.  Nutritionist or dietician is not covered but the psych eval is covered with a co-pay as well.   Hope this helps. Anna

I have blue cross hmo they cover gastric bypass butthey domake you do 6 months to a year of supervised weight loss and requie  you to lose 10% of your weight now they wayto get around that is to lose the 10% really fast like i did.

I have BCBS of Alabama PPO.  They do require a 6-month supervised diet and a 3-year history of morbid obesity.  They will approve only VBG and gastric bypass.  Below is the link to the current policy for all the requirements and rationales for the suprvised diet. https://www.bcbsal.org/providers/policies/final/053.pdf They do not cover LapBand at this time.  As you can see in the below-referenced policy, they removed the "investigational" language and simply indicate that it is not covered. https://www.bcbsal.org/providers/policies/final/031.pdf I have completed the 6-month diet and all testing and my surgeon has submitted for approval.  I will post when I get BCBS's answer. Hope this helps someone get approved.

Alright ya'll...I said I'd post when I got approved.  Well...I got the letter today that I was approved on 9/12, the same day I posted the above entry....ironic huh?  The insurance advocate at my surgeon's office was just as surprised as I was to get the approval so soon. If anyone wants any more information about what I did to get approved through this insurance company, you are welcome to e-mail me at [email protected] and I would be glad to help. Good luck everyone!

Hello Angela, Please let me know how it turns out. I have BCBS of NC, and I have Gary appealing my denial of lapband.  I see that they have agreed to review lapband in Aug of 06, but BCBS of NC hasnt posted that page that bcbs of alabama has. I hope it is NOT the same policy!!! Please let me know. Steve T

Steve: I got approved for RNY.  I know they just reviewed the LapBand policy in August, 2006 and they still will not approve it.  I checked the website for BCBS of NC and their's does not read exactly as mine does, so you may have a chance of getting approved.  Yours doesn't seem to have a policy only on LabBand like mine does, it seem to be lumped in with all the surgeries together.  I hope Gary can get your denial reversed. Good luck,

I have BCBS of Kansas City,  I am going to look into having the lap-band surgery and I will post again once I find out more information. I hope and pray they will cover it. Kyle

Blue Cross Blue Shield of Kansas sent the following letter. It has been determined  this service would not be eligible for benefits under this patients contract, as any service or supply provided directly for or relative to the medical management of obesity is excluded from coverage.This includes but is not limited to surgery, office visits, hospitalizations, laboratory and radiology services, prescription drugs medical weight reduction programs nutrients and diet counceling. Prescription drugs utilized primary for the treatment of obesity are excluded. The exclusion applies even if the drug is prescribed for purposes other than the treatment of obesity. Obviously BCBS of Kansas is descriminating against obese people to the point that treatment for other ailments are not covered just in case a weightloss side effect may occur. My secondary insurance is Medicare. They will cover this surgery without much hassle as long as you are not over 65 and you have it done at a bariatric surgical center of excelence. Certified by the ASBS There are not that many around that take Medicare. Kansas has none. My wifes secondary insurance is ChampVA.  Notice that's VA NOT US! DO NOT confuse it with Tricare!   ChampVA will cover this surgery without any hassle as long as it is medicaly necessary.