CareFirst BC/BS, no bariatric coverage

I have Care First Blue Cross/ Blue Shield and I called them to see what they require prior to Lap Band surgery and they informed me that it is not covered under my policy.  Dr. VonReuden is covered but not any bariatric surgery.  Can this be true?? My BMI is 57 and I have sleep apnea so I know that it will be deemed medically necessary but I have no idea of what to expect. Any insights? JoAnna Wilson, Maryland

First of all...most (not all, but most) BCBS do not cover lap bands...only gastric bypass. Second, it sounds like you may have an exclusion for bariatric surgery on your policy...that is not decided by BCBS but rather by your employer...they can chose to exclude bariatric surgery as a covered option to save money on the policy. My suggestion also is to not try to get information over the phone...many times you will be told something different every time you call.  Request a hard copy of your exact policy and check to make sure if bariatric surgery of any kind is covered.  If it is not, then you might want to speak with someone in your employer's benefits department about a possible exclusion. Sorry that's not very helpful right now, but getting a copy of your policy and going over it is your best first step to take.

The majority of BC/BS DO cover lapband as of 2007!  The only thing I am running up against is that my plan in WA state a Federal plan will not pre-approve, get the surgery and hope they pay!

That's tough...if you go that route, I guess you had better be ready to self pay just in case huh?  My insurance approved the surgery and still haven't paid my surgeon and I had surgery in October...go figure.

I also have TriCare Prime thru the hubby- I see them on Friday to see where they will fall in all of this- Hopefully one or the other or both will end up covering it all.  Keeping my fingers crossed!

I have Carefirst BC/BS.  I am also using doctor Von Reuden's office.  I am actually using Dr. Moein for my lapband.  I called and they said that they do cover.  The docs office sent my file to them yesterday for approval.  I am still waiting to hear back.  It's very possible that it has something to do with your employer.  I have called Carefirst 4 times since first hearing about the LB and they have told me each time that I was covered.