BCBS of NC
(deactivated member)
on 4/29/08 12:07 pm - NC
on 4/29/08 12:07 pm - NC
I have BCBS of NC Blue Options. I know they will cover the RNY and LapBand , but they still have the Vertical Sleeve Gasterectomy classified as investigational. I have heard this means I don't stand a chance against them with appeals. Is this true? I guess my question is, if I'm too big for a LapBand (BMI is too high) and I am not a good candidate for RNY, am I just out of luck?? Are investigational surgeries EVER covered if a doctor decides it is the best surgery for a particular patient? Or, am I doomed to live out whatever life I have left as an invalid, because that's what is going to happen if I don't do something about my weight.
My BMI was over 65 and I was able to have the lapband and I am only 8 months out and I have lost 75 lbs. I saw a another patient in my surgeons office yesterday that had a bmi of almost 75 and she had the lapband. I was not a candidate for RNY due to my lung diease but I am happy with the choice I had and love my lapband. But if something is investigational its almost impossible to fight unless you get a lawyer and then sometimes they are unsuccessful too.