Question:
BCBS Insurance with the Lap-Band

I know that if you are having the RNY that you have to have a 6 months monitored diet before you can get approval with BCBS, does anyone know if you have to do the 6 months if you are having the lap-band done?? Thanks :) Beth    — Elizabeth H. (posted on September 8, 2008)

September 7, 2008
I don't know your plan specifically, but I have Blue Shield and they did not require six months of anything. Also, my surgeon's office tried to tell me they require a cardiology consult, but they don't. Just make sure you do what your INSURANCE says you need to do, not the surgeon's office ... I'm sure you know this, but I figured it was worth mentioning regardless!
   — lauren_marie

September 8, 2008
I have BCBS of AR and was not required to do a 6 month monitored diet for RNY. My friend had lapband by the same surgeon and she's on the same insurance and she wasn't required either. It's based on your medical history and if you have any current qualifiers (blood pressure issues, sleep apnea, diabetes, etc.). So my recommendation is to let your doctor send in your pre qualifying information and see what they say. It's different for everyone, but for me, BCBS didn't make me do that. Hope that helps.
   — MandyR

September 8, 2008
I believe that if you have BCBS HMO you are required to have the 6 months diet plan. I have regular BCBS where you pay a percent of amount due to the doctor and hospital. With the HMO you are not required to pay a percent, just a copayment. Check with your insurance company.
   — Toby2

September 8, 2008
Hey there! I have BCBS IL PPO and they have the 6 month requirement, regardless of Lap Band or RNY and it also does not matter if you have co-morbidities. As long as your BMI is greater than 40 and you meet the additional req's. The best advice I can personally give you is to call your insurance or go to their website. The website for my insurance clearly lists the requirements. I am SO bummed about the 6 month req. It is holding off my approval (that's the only think I am lacking at this point) :-(. Hope this helps =)
   — Sweet_Escape

September 8, 2008
We live in Delaware and have Blue Cross/Blue Shield. Both of my daughters have to attend 6 months of sessions and if they miss just one month... they have to start them over again. They are both having lap bands done. If you have been on a medically observed diet and can prove it... such as your doctor, or weight watchers and there may be others then you only have to do 3 months of the sessions. They both just found out that if they don't have all the necessary appointments done by cardiac, pulmonary, etc., they must keep going to the sessions until time of the surgery. Different BC/BS companies may have different rules though. I would call them and ask for your specific benefits. Hope this helps.
   — dazie711

September 8, 2008
the 6 month dr supervised diet is WLS specific -- it is not specific to the TYPE of surgery you are having -- good luck
   — RCassety

September 8, 2008
When I had BCBS of IL, I was required to do the 6 mos for the Lapband because I didnt have any health issues. I was required to lose 5-10% of my total body wgt. My dietician told me not to lose too much or too little because I could be denied.
   — lakia1908

September 8, 2008
Every insurance carrier will be different. BCBS of Alabama does require the 6 months of PCP visits.
   — Keith Smith

September 9, 2008
I have BCBS of Nebraska and was not required to do any weight loss for my surgery which is scheduled for 10/07/08--Lap band. I think each state has there own requirements.
   — Teresa J.

September 10, 2008
I have aetna. Aetna requires either the 6 month program or a 3 month surgical prep program with the hospital. I would strongly suggest you do what has been mentioned earlier and check with your carrier. The last thing you want to do is too much or not enough and be disappointed.
   — bcrobey

September 13, 2008
It depends on the state you live in and your specific Plan. My BCBS of FL had only one requirement: that you pay for your WLS yourself as all are plan exclusions. Call and find out to be sure. Good luck, Dawn Vickers, RN, BLC, CLC
   — DawnVic

September 21, 2008
I have BCBS IL I wanted lapband first and they required me to do the 6 mos supervised dieting along with all the other requirements. They denied me repeatedly until I finally switched to RNY and was approved the first try. Good luck to you!
   — Fluffee

September 23, 2008
I have bcbs of az, I was told by my dr that the diet history/food journal was no longer needed (being that the rules had been relaxed) and all I needed was a dietary cons with a registered dietitian along with my eval from the shrink. :) Every bcbs plan is different. Good Luck. I received my approval in 4 days.
   — Melanie Watson

Click Here to Return