Any Fruit of the Loom employees? Ins. question...

My husband has his insurance, BCBS, through his work at Raybun Apparel, in Raybun Gap. I am hoping to have the Lap Band procedure, but don't know if they will cover. I know that FOTL has their own policy through BCBS, so I was just wondering if anyone has been through an approval process with them? Thanks in advance!

WELCOME TO THE BOARD, MS ELIZABETH. GLAD TO SEE YOU HERE & HOPE YOU BECOME A REGULAR WITH US. ALTHOUGH I CAN'T TELL YOU SPECIFICALLY IF YOUR POLICY WILL COVER LAP BANDS, ALL YOU HAVE TO DO IS CALL THEIR REPRESENTATIVE & ASK IF THEY COVER "MEDICALLY-NECESSARY WEIGHT LOSS SURGERY" ... BE SURE TO SAY, "MEDICALLY NECESSARY". THEN, IF THEY DO, ASK IF THE LAP BAND PROCEDURE IS COVERED IN PARTICULAR. ALSO ASK WHAT THEIR CRITERIA IS FOR APPROVAL SO YOU WILL KNOW WHAT CO-MORBS QUALIFY YOU & WHAT YOU WILL NEED TO DO ... GET A LETTER OF MEDICAL NECESSITY ... GO ON A DOCTOR SUPERVISED DIET ... GET CERTAIN MEDICAL & PSYCH TESTS ... ETC. IT CAN BE A CONFUSING PROCESS ... SO PATIENCE & DON'T GIVE UP! GOD BLESS YOU DAWN & NICK PS: I ADDED YOU TO OUR SC WEIGHT LOSS BOARD. IS SENECA IN THE LOWCOUNTRY, MID OR UPSTATE?

Thank you Dawn! I really appreciate your warm welcome. Since posting my initial post, I have been to the seminar by the surgeon to find out what he requires, have called my insurance company and made an appointment to get a referral from my PCP. The insurance company is totally frustrating, in that they don't make their requirements clear. They said the Lap Band is covered if deemed medically necessary, but wouldn't explain what medically necessary meant, except that my surgeon's paperwork would go through a medical review, and approval would be based on the review. Wow, that sure cleared things up for me. not. lol SO, at least I have the ball rolling, and I'm praying hard that this is God's will for me! Thanks again! And Seneca is upstate...up in the "golden corner" by the GA & NC border. Blessings, Elizabeth

OH WOW, YOU HAVE REALLY PUT FORTH SOME GREAT EFFORT, MS ELIZABETH ... GOOD FOR YOU. VERY NORMAL ... MOST INSURANCE COMPANIES ARE LIKE THAT ... IN GENERAL, MEDICALLY NECESSARY MEANS THAT YOU HAVE A BMI OF 40 OR MORE ... YOU ARE AT LEAST 100 #s OVERWEIGHT (SOME WILL GO AS LOW AS A BMI OF 38 & 80 #s WITH A LOT, LOT, LOT OF CO-MORBS) & YOU HAVE AT LEAST ONE CO-MORB. USUALLY, THEY EXPECT THAT YOU BE MEDICALLY OBESE FOR AT LEAST 3 YEARS & HAVE TRIED & FAILED AT SEVERAL DIETS & EXERCISE PROGRAMS. LIKE, WHO HASN'T!?! I HAVE A LONG LIST OF CO-MORBS THAT I SEND OUT TO ANYONE WHO WANTS IT ... YOU'LL BE SURPRISED AT WHAT THEY CONSIDER CO-MORBS. SINCE YOUR INSURANCE COMPANY IS ONE WHO IS NOT FORTHCOMING WITH THEIR CRITERIA REQUIREMENTS, I WOULD SUGGEST THAT YOU DO SOME EXTRA WORK TO BENEFIT YOURSELF IN THE APPROVAL PROCESS. I DID THIS & HAVE SUGGESTED THIS TO SEVERAL OTHER PEOPLE & IT SEEMS TO WORK. BE PRO-ACTIVE IN THIS PROCESS & WRITE 2 VERY DETAILED DOCUMENTS ... ONE DETAILING EVERY SINGLE MEDICAL ISSUE YOU HAVE & HOW IT NEGATIVELY IMPACTS YOUR LIFE ... I EVEN WROTE HOW MY BRA STRAPS DUG INTO MY SHOULDERS & CAUSED ME SUCH PAIN & NERVE DAMAGE ... WRITE EVERYTHING IN DETAIL! THE 2and DOCUMENT SHOULD BE ABOUT YOUR LIFESTYLE PROBLEMS & BE BRUTALLY HONEST ... REMEMBER, YOU ARE WORKING WITH HUMAN BEINGS & THEY ARE SWAYED BY THE STRUGGLES OF OTHERS. THIS WILL BE EMBARRASSING, BUT NO ONE DIED OF EMBARRASSMENT ... YOU CAN DIE OF BEING OBESE. SO, IN THE 2nd DOCUMENT, IF YOU CAN'T GET IN & OUT OF THE SHOWER BY YOURSELF & NEED HELP, THEN SAY THAT ... IF SEX IS HARD, OR PAINFUL, OR YOU ARE UNABLE TO PARTICIPATE AT ALL, THEN BE BLUNT IN YOUR DESCRIPTION OF HOW THIS EFFECTS YOU & YOUR HUSBAND ... IF YOU CAN'T PICK UP, OR DON'T HAVE THE ENERGY TO PLAY WITH YOUR CHILDREN, TELL THEM HOW YOUR HEART ACHES BECAUSE YOU ARE MISSING OUT ON THEIR CHILDHOOD. BE SURE TO MENTION THAT YOU HAVE TRIED & FAILED WHATEVER DIETS & EXERCISE PROGRAMS & FEEL THAT THIS WILL HELP YOU OVERCOME THE EFFECTS OF YO-YO DIETING, SLOW MOTABOLISM & GENETICS SO THAT YOUR EFFORTS WILL BE SUCCESSFUL. LET THEM KNOW THAT YOU UNDERSTAND THAT THIS IS A LIFETIME COMMITMENT; THERE IS NO "GOING BACK" AFTER WLS ... NO REVERSAL ... YOU ARE DETERMINED. I'LL POST THE CO-MORB LIST HERE ON THE BOARD AS THERE ARE A LOT OF OTHER NEWBIES IT MAY BENEFIT AS WELL. STAY FOCUSED & DON'T GIVE UP ... THIS ISN'T EASY, BUT IT IS WORTH IT! GOD BLESS YOU DAWN & NICK