BCBS Blue Cross says they cover CPT 43775

Okay folks...So I called my specific Anthem Blue Cross (thru California, even tho I live in Arizona) and specifically asked if they are covering CPT code 43775 (the code for a lap sleeve procedure).  And they said YES...  Could it be that BCBS is coming around finally?  I want to hear from other Blue Crossers who have been checking on this stuff in the last couple of months...Any updates?  Whatcha hearing from your insurance peeps?

Thanks for your post, I'm currently on my Level 1 appeal with BC/BS. I spoke with them today concerning when I would here something.They told me within 5 business days they would have a response. I hope your right, I put together what I think is a pretty undeniable appeal. BC/BS of Oklahoma, uses their bariatric policy SUR 716.003 as the basis for their denials, it contains 51 references, that on average are 11.5 yrs. old, 5 are over 23 yrs. old and only 3 even mention SG. Total piece of garbage to say the least. Do they use this policy any where else?

There are two different documents I have seen relating to Anthem BCBS policies concerning VSG.  One referred to it as experimental and states that the policy was last updated on 08/29/09 and the other is the PreAuthorization List of CPT codes dated 01/25/10 where it states that VSG just needs "letter of intent documenting medical necessity".  I have decided that if they are going to cause problems later when the actual pre authorization happens, I am going to fax the pages of the PreAuth list related to VSG.  I am encouraged, at least, that I have a document and phone confirmation of the policy.

Thanks for posting!

I have BCBS MD and have had my SG approved.  BMI of 40, high cholesterol, mild sleep disorder.  Approval took about a week

Destined, unless I'm mistaken Maryland is a special case with bariatric research. It seams that BC/BS has been giving favorable rulings in that area for a while. Please respond if you know differently. I'm getting on the elliptical trainer for a while and will respond later, thanks.

Steve,

Laurie, I also have Anthem BC in California. Now, I'm on an HMO plan, but I don't think that matters as much. I was approved for BOTH the sleeve and RNY at my surgeon's request. It went through quite fast, too. Keep in mind, though that my authorization went in with me at a BMI of 75 with pseudotumor cerebri, hyptertension and sleep hypopnea (on bipap w/ O2)

As of now, I'm having the RNY.... but I'm close to changing my mind.

I have BC/BS of Alabama and they didn't cover mine. I was self pay but it was worth every penny.

I think it really depends on where you are, physically. Rinarut, it looks like you went in on the low end of the BMI scale, so that's probably why they wouldn't cover it.

My BMI is the standard 40 (actually 40.3). Zilly - you would probably have less health issues if you went with the VSG.  That is what sold me on it ultimately...

Thanks. There are benefits to both surgeries to be sure. For me, I'm concerned about anemia. It's a common issue in my family, and now... even with supplements, my labs are on the very low end of normal.  I see my surgeon next week for my final pre-op appt, and we will make the final decision then.

I know he prefers I go with the bypass... but for me, I feel good knowing that I have approval for both at this point.

This next week is a tough one as I sort through everything.