Federal BC/BS

GreytDog · 03-16-2006, 08:34 AM

Got a fun phone call yesterday...

About a month and a half after I received a letter and phone call informing me that my surgery was approved and that I just had to wait for the specific doctor to be approved, I received yesterday's call telling me they made a mistake.

Federal BC/BS won't cover LAP-BAND® but they'll cover the regular gastric bypass surgery.

DH asked what would have happened if I'd already had the surgery...and the rep said we would have had a big problem.

(sigh)

Supposedly, I can write a letter of protest. Think there's any hope?

Mvpo8961 · 03-22-2006, 12:06 AM

I don't know but I wish you luck. M

BarbaraC · 03-24-2006, 08:54 PM

I am a federal employee. I do not and have not have BCBS but I do know that a few people have tied to get them to approval the band and all have been turned down. I also read where one was approved had the surgery then had to pay the money back since it was not a covered procedure. I had Kaiser HMO last yr and they would not pay for LAP-BAND® so I changed to GEHA who is approving the band this yr. So my advice is wait for the open season then change co. In the mean time get going the at least 6 month Physican diet. Good luck

paula · 03-25-2006, 11:21 AM

Yep! I have BC/BS Fed.

When I was banded, we had First Health. They paid for banding surgery - and fills were only my co-pay fee. Nice, huh?

Then we switched to BC/BS 6 months later.
And yep, thats right, AGB is NOT covered. Ive called and asked (pleaded) many times - hopeing that since I already had the band - that they would pay for fills/unfills. But nope!

NOW! Here's the bullseye...
IF you are already banded and you develop problems - they will pay for testing. And just like others have said, if you need your band removed, then there is a way you can be admitted through ER and BCBS should cover removal. Alot of it has to do with proper coding too.