Question:
How do I get a straight answer from my insurance company?

I went to the seminar for the lap band procedure and they told us to call our insurance company and make sure they cover the surgery, Well I havent gotten a straight answer from them yet. I have called them SIX times and one peson tells me Yes they cover it and another tells me NO they dont cover it. This has been going on for a week now If anyone can help me Id really appriciate it. I have Blue Cross Blue Shield and they dont seem like they want to help, its like I am a bother to them.    — Dee52 (posted on March 23, 2006)

March 22, 2006
Denise, When I called to find out if the surgery was covered the insurance asked for the coding number. As I was talking to the lady at the insurance company she asked for it and I told her I didn't have a number. She called the Doctors office and got the number for me. Well she called back and told me it was covered and she even gave me the number. You might try calling with a coding number. Good luck!
   — Sheila_E

March 23, 2006
Denise, ask BCBS for their written manual on what they cover for bariatric surgery. I used BCBS of IL and they directed me over the phone to their website version of their manual (that they update yearly) and there I can read line for line what types of procedures they do and don't cover and what stipulations there are... Just call and ask them to direct you online to where you would go to see such information. And demand it... don't take no for an answer! Good luck!
   — SJSlesnick

March 23, 2006
You need to read the most current copy of your policy and see if WLS is covered or not. A coding # has nothing to do with if it is a covered procedure or not, all procedures have coding #'s, even non covered procedures. All cases are coded in the hospital including free care and self pay. 1 reason records are coded are for statistical purposes. Just becuase you have a code# it doesn't equal payment from the insurance company.Unless you can afford to be self pay, its worth the effort to obtain this information before you proceed further in your journey. Also you could call your benefits person in HR and check with them about if WLs is covered. Good Luck good Luck
   — goldroses

March 23, 2006
When I decided to do the procedure, all I did was make an appointment with the surgeon I was considering. After I decided to go ahead with it, they did it all for me. I never once called my Insurance company. I was approved right away. I have Oxford Freedom Plan. Good Luck!
   — MikeL

March 23, 2006
Insurance companies (eyes rolling)! Of course it seems that they don't want to help you. As long as you are healthy and they are taking your cash, you are their friend, if you want to spend their money -- that's a whole different story. My insurance company did the same thing to me... covered, not covered, different day, different answer! Eventually, they became consistent with the denial and only changed their rational -- medically necessary but excluded; not medically necessary (even though my surgeon deemed it medically necessary).... You have to get your surgeon to submit the request in writing, and then the insurance needs to respond in writing -- once it's in writing, you have your answer... As for me, I'm heading to Brazil in 10 days for a self-pay duodenal switch and a couple weeks in beautiful Curitiba! :)
   — [Deactivated Member]

March 24, 2006
Denise, I have BC/BS PPO. I had just about the same thing happen to me, different day, different story. The suggestion about the code #...they are right. BC/BS will ask for a code #. That is what they use to tell you if the procedure is covered or not. Either your surgeon or your PCP should be able to give you that number. If you have any question, don't hesitate to e-mail me and ask. I wish you the best of luck! Steph :)
   — squeekypete