Blue Cross Blue Shield Federal of Maine

Has anyone had or is anyone been approved for LAP-BAND® surgery by Blue Cross Blue Shield Federal of Maine? My husband works on the Portsmouth Naval Shipyard in Kittery, ME and I wondered if anyone has already gone through the process with them as far as what they cover for the surgery? Also, if they do cover it, what did you have to do to qualify? Thanks, Laurie

I don't know about Blue Cross/Blue Shield in Maine, but I do have the federal employees Blue Cross - probably is the same. Blue Cross does cover LAP-BAND® surgery. Now, they may require that you have 6 months of surpervised weight loss with a doctor. It kind of depends what is in your records. I was approved in 3 days. It was fast.A general rule of thumb is that most doctors and insurance companies will not consider it unless your BMI is at least 35 and then no more than 60. If it is 60, you will have go on a weight loss diet to get your weight below that.

I too have Federal BCBS. Your federal plan does approve LBS, however, the state in which you are HAVING the surgery is the state that the approval comes from. I live in Illinois, but BC Kentucky was my approving agency. I had a BMI of 35 and was approved within about 20 days. The federal program can only hold your approval for 31 days. They are required to give an approval or denial in that time frame. At present a 6 month diet requirement is not required. But state BCBS does require it.
To submit an approval request, you must do all the pre-op stuff as everyone else requires: sleep study, labs, cardiology stuff, respiratory tests, psych eval (out of pocket expense-not covered), etc. A letter from your primary, along with a personal letter.
Your surgeon knows what is required and will help you along the way.
Go for it!

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Mely
“The greater danger for most of us lies not in setting our aim too high and falling short; but in setting our aim too low, and achieving our mark.”
Michelangelo

I have BCBS Federal and live in Kentucky. I was approved and had my band one week ago. It was a quick process. I didn't have to do a diet before either. Of course, my BMI was over 40 so that may be why.

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Surgery date: June 24, 2008

Thread Starter

Hi Kristiie,
You just had it done last week? How do you feel? Are you up and about and eating? Sorry, I'm so full of questions but I am just starting to research this. Thanks so much and good luck to you. Hope you feel better soon. You look beautiful in the picture so I can only imagine how you'll look later!!
Thanks, Laurie