Question:
I have anthem bc/bs, they said lap wls to experimental to pay for

I was wondering if anyone who has anthem bc/bs of Ky has be denied lap band wls because they feel it is to experimental for them to pay for it. Can I appeal?    — penelope R. (posted on February 5, 2004)

February 5, 2004
I have BCBS OK and also BCBS California. BCBS OK flat denied any and all weight loss surgery as an exclusion. California told me over the phone that they would pay for the lap band but then when all the paperwork was sent in they denied it on the basis that it was experimental. I found a page on their website that made that statement also. I was told that there was no point in trying to appeal it since it was in writing in their policy. So I reapplied for a rny and they approved it. I had open rny in December. It was not what I had originally wanted but I am happy with my decision. Good luck in whatever you choose to do.
   — Michele P.

February 5, 2004
I have Anthem of Virginia. I fought them for a year on lap band coverage. I went through four appeals and denials. My last appeal was in person even though I flew to Virginia from ohio to plead in person. Still lost....They did cover the RnY with no problem though.
   — lindadougherty

February 5, 2004
I had BCBS anthem of maine, they out right denied me for the lap band saying it was experimental and approved me right away for RNY I had my surgery on 02/25/03.
   — Janine B.

February 6, 2004
I live in Connecticut and also have Anthem BC/BS. I had the same exact response from them - out right refusal. Actually, my surgeon's office new right from the get go that they simply do not approve it as they feel it is too experimental (although they also told me the bigger reason for this denial is due to cost issues - open is less as they use less technology) They did however approve my open rny within 12 hours and I had surgery on 1/30/04. Doing great and down 17.5 pounds.
   — Megan S.

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