New to this.

Hi all! This is the first time that I have been to this site. I am from Prestonsburg Ky. I have done some research on the Lap Band and I am very interested in proceeding this. My question to you all is about the insurance. Does anyone have Blue Cross Blue Shield of Alabama? IF so, how hard was it to get approval? :-) Thanks to all Angela

Hi Angela I have Anthem bc and they approved me with medical necessity. It didn't take very long at all just have to get your ducks in a row. Your first step should be to call your insurance co. to see if they cover and what they require. Char

Thanks for responding! Is Anthem the same as BC/BS of Al? Not sure, but I did call them and they dont cover for the lap band just for the Gastric bypass. But I was told, by a the doctors office that I am going through (Louisville Surgical Bariatric Asso), that they will appeal my case if denied and go from there. I do have some medical necessities so hopefully it will go through. So you got approved, thats wonderful! does your insurance company pay for everything? How much have you lost?

who is your dr. Mine is Dr. Shina at Nortons. char

Angela, Did the insurance say why they don't cover Lap Band? Did they say "exclusion?" Get specific information from your insurance...call them again...the Customer Service Rep could have been wrong. It happens....Ask to speak to Medical Review or whoever actually approves/disapproves these surgeries. Don't take "no" for an answer. If there is a written exclusion to your policy though...I don't think appeals will help. At least that is what I have heard. I think that Anthem and BCBS is the same....however, the policies can definately vary. I have Anthem...I actually work for a sub-division of Anthem. The policy is set up either through employment or private pay. That is the reason it can vary...you may also check with the employer that the policy is through. I was out on the website and researched like crazy. When all else failed, I called them. I spoke to the nurses that review the claims. She told me exactly what is needed: BMI 35-40 must have comorbidities (medical conditions)...my BMI was exactly 35 and I was approved (after appeal) due to sleep apnea, reflux, failed weight loss attempts, very high risk of diabetes, high cholesterol, etc. My friend was approved with a BMI > 40 in less than a week. She had less conditions than I did but her BMI did it for her. So...it varies... You are doing the right thing by researching and asking questions. Good luck!!

Thanks for the info! I will definetly be calling the insurance company again. How much weight have you lost thus far? My BMI is right at 35 as well. I to have the same comorbidities as you do. I also called the BCBS and they said they are not the same as Anthem. So, now I guess I should just go to the seminar and fill out the paper work and just see what happens.??? Dont you think? IF not approved I can try and do something else, we'll see... Thanks again for repsonding :-)

BCBS is different with every company. My husband is insured with BCBS through Central States (Teamsters) and it was denied..flat out, no way. Luckily we had back up insurance through the military that covered it right away. Check with your insurance company to see if it is an "excluded item" or just one that has to be medically reviewed.

Hi and welcome! I haven't been on here much lately but if u ever have surgery questions or concerns feel free to email me anytime. I had my gastric bypass 2 yrs ago now with Dr Shina. I lost 170lbs all together and have been at goal and maintaining for over a year now. I wish u the best. Hugs and Best Wishes Angela R email [email protected] messenger [email protected]

Thanks to you all for responding! It helps to know there is support out there :-) First of all... I'm thinking about going to Dr. Wheeler (sp) in Ashland Ky if I can get approved. I havent attended any seminars yet, but will shortly. I called my insurance company and they told me they do not cover for Lap band surgery but they do for gastric and/or vertical banded? Whatever that is. They did say there are "no exclusions" I dont know what that means either. So, now I am waiting for my password to my insurance so I can go online to read about what my insurance will cover and what they wont. These people are so confusing to me! lol My BMI is 35.1 I do have reflux, shortness of breath, pains in the joints, sleep disturbance etc. I'm 5'2 and weight 192. Last time I checked. Thanks for any help out there. I do apprecaite it! Angela

Hi Angela, Insurance can be so darn confusing. I have BCBS FEP and I called them before my surgery to find out all the info I could. I didn't hang up with them until I was satisfied that I understood what they were telling me and that I knew what was and what wasn't covered along with what was needed when the claim was submitted to them through my surgeon's office. I didn't want to be left in the dark about anything so that I didn't run across any little 'surprises' later on. You can always call back, explain that you talked to someone but have additional questions....like what does it mean when they said "no exclusions". Chris