BC/BS Insurance question

Hi. I have a couple questions.  My cousin is interested in having the lap band surgery, and she has BC/BS of TN,  but she doesn't know if the insurance covers wls, or to have the band put in. She lives in Western TN, so either Nashville or Memphis would be the best.  If anyone has any information for me to pass on to her, I would greatly appreciate it.  I am always on the Indiana board, so feel free to look me up if you have any other information.

I have BC/BS TN but mine is the Fedreal Program  They do cover lap band and gastric bypass on my plan. Sue

I am not sure which plan she is on, but thanks for the tip.

I used to have BC/BS of Aln (live in Nashville) because that's where the main office was, they covered the gastric bypass but no other WLS surgery. That was over a year ago and maybe they have changed since then. Debbie

Thats good to know that some forms of wls are approved thru them. Thanks.

It all depends on her employer and whether the employer has chosen that as an option.  Some employers make specific exclusions for wls.  She can call her BC number on the card, and ask them whether its covered for medical necessity, and to lead her to the manual on their website so she can print out the qualifications.

That was what I told her, because I know certain plans cover more than others.  Thanks for letting me know, and I will pass the information along, so she will know what to expect.

What Mel said, it depends on the employer. Even though a plan may be BCBS of TN, if the employer does not add the coverage for WLS, it will not cover it even if medically necessary. I am the benefits coordinator for my employer. We have BCBS of TN but we have an exclusion for any type of WLS or medical treatment for obesity. The option to cover treatment of morbid obesity is very expensive and drives the premiums up for everyone on the plan even if only a few would qualify to use that option. I am on my husband's insurance (BCBS of MN) and they covered mine. It's really hard for me to have to tell our employees that the plan does not cover the surgery when they see how well I've done and they ask about having it done. I've had to tell 4 employees that it is not covered and it breaks my heart each time. Have your sister call the customer service number on her card. They will be able to tell her if the plan covers the surgery as well as what the requirements are. She might also want to go to the BCBS website for her plan and read the plan coverage for herself. Unless she finds wording specifically excluding the surgery and/or treatment of morbid obesity, I would assume they cover it and move forward. The insurance coordinator at the surgery clinics would also be able to find out if her particular plan covers the surgery. I wish her luck and coverage!!

Thanks, Susan. My cousin and I have been chatting back and forth for several weeks on this, and she knows what all I had to go thru to have my wls approved.  She was planning on calling BC/BS this morning, and checking with her plan to see what is and isn't covered.  She knows of others that work for the same company that have had RNY, but not lap-band, so that is the hurdle that she really wants to get over first. Thanks again for all the replies and help. I am going to copy all of this, and send it to her.  She has been checking out OH, and I told her to make sure to check out the TN board, so she can get the local support that she so dearly needs. I know that the IN board has helped me so much as well! 

She's got to check with BC/BS to verify what her plan does/doesn't cover. If she's in northwestern Tennessee, like me, she might want to consider going to Paducah, KY to see my surgeon, Alex Argotte (tel: 270-538-5850).  It's closer than Memphis or Nashville and he has an excellent program with very thorough education and aftercare.  Plus, he's a doll.  Just a thought.