Has anyone gotten APPROVAL for lap band surgery from BC/BS of Georgia?
I am just beginning the process. It is NOT a written exclusion, but says it is covered for patients meeting their Medical Necessity criteria, as defined by BS/BS of GA. Pre-certification is also required. I am in Washington state, but my husband's company/insurance is based in Georgia. I already know of the clinic and surgeons/hospital I will go to here IF I get approved.
I have BCBS (I am in La). I checked my policy book for exclusions, and it said it excludes WLS but will approve for morbid obesity.. (BMI 40 and when determined as medical necessity). We called the number on the card for further information. According to them, they will approve lap band, Roux N Y, and so on. They had a long list that they read my husband over the phone. According to her, the thing was ... was BMI 40 or 35 with co-morbidities.
My Dr. office said to call and see if our policy itself had a written exclusion............ some bought by employers for their employees do. If not, then you meet the requirements set out in your policy book. So find your book, or call the number on your card and give the lady your numbers off of your card. They will pull up the policy you have and be able to tell you what is in the actual policy for the company that your husband works for. It can vary from employer to employer, within the state. Walmart here has BCBS but they bought policy with a written WLS exclusion....... It did not appear that BCBS had a problem with lapbands.