BCBS Blue Cross says they cover CPT 43775

Just be clear - because they cover it does not mean it will be approved on first request.  

I phoned my insurance (Health Net)  THREE TIMES to be absolutely sure the procedure was covered so I would not get a denial and it was denied anyway as investigational.  They *will* cover it as it is NOT EXCLUDED but they need buttloads of info and an appeal to do so --- IN MY CASE.

Again, just be clear with them. 

I was going through my reference material and I was mistaken on the BC/BS of Maryland coverage; the favorable BC/BS coverages have been coming from Michigan, so that does appear to be a break through in the Maryland area, as indicated by the post from "destined". Anyone with BC/BS that is any level of pre- authorization to appeals, I strongly encourage you to keep up the fight and Please keep us all posted, I'm committed to do the same.
Thanks all. 

Hi there,

I have Anthem BCBS in Georgia. I am going for my first visit with the Dr I want to do my sleeve with next week. I will keep put up a post after once I hear whether they will cover it without me having to go through the appeal process (which I am prepared to do).  I am praying they will just go ahead and approve me and get it over with.

I too have BCBS of California, but I live in Arizona. My paperwork was just submitted so I am hoping to hear soon! I figured my Dr. would have filled me in on info if he hasn't seen them approved before from BCBS! I hope that is the case anyway! Well good luck!

Jena

I hope that is good news but just be careful and don't get your hopes up too much. I called when I was first looking into VSG also and was told the same thing via phone but when it was submitted on paper, it was denied. I did end up appealing and won but just be careful what they tell you over the phone, if you can make them put it in writing, do so.

BCBS PPO of MI covered my VSG.  No problems whatsoever.

As of January 1 of this year, most Blue Cross Blue Shield plans cover the sleeve (CPT 43775).  Of course there are some holdouts, e.g., as of April 1 I believe BCBS federal was not covering the procedure.

laurie

i had the gastric sleeve done Sept 28Th,and have done really well..it does take a lot of getting used to,BUT on the other hand i will tell you you have gotten through the hardest part already(INSURANCE) i have bcbs as well and they gave  me the same troubles. BCBS is just a SLACKER COMPANY they will hold out as long as they can,so for everyone else that hasn't been approved DONT STOP BUGGING THEM!!!!!!!!!!!!!!!!!!! THATS THE ONLY WAY YOU CAN GET IT DONE...my wife also is having this procedure done i called BCBS back and they approved it same day so dont give up!!



i am an EMT and going through medical school,and here if ANYONE HAS QUESTIONS feel free to email me i will answer asap                           [email protected]


GOOD LUCK LAURIE AND ALL OTHERS WHO ARE HAVING THIS PROCEDURE!!!!!!!!!!!!!!!!!!!