Highmark BCBS

skinnysoon

Anyone in CA had success getting Highmark/ Blue Cross Blue Shield to cover their Lap Band procedure? I've been denied saying it was experimental. I understand others have been approved in other states so I need to know if anyone in CA has been approved/had surgery. This info will help me in my fight! I need all the help I can get . . . THANK YOU!

ladysplenda

I am having the same problem.As of today I have been denied twice.There reason this time was that they will cover gastric banding but not Lap Band because it is not FDA approved.The employees of Highmark were issued a memo a month ago that Railroad employees will be covered for Gastric Banding.What do they think gastric banding is if not Lap Band.No one does a simple band anymore.My doctors office said it is FDA approved.I am diabetic and I have had six months of nutrion couseling and a mental evaluation.This is what they require for gastric Bypass to be approved.Im scared of Gastric Bypass.I was sure after I heard that they were paying for gastric Banding that thuis time I would get approved. IM NOT GIVING UP YOU SHOULD NOT EITHER.I was told to have my doctors office call the number on my letter of turn down and to have him tell them it is the samething as gastric banding and it is FDA approved.Do you or your mate work for the railroad??
Please add me to your friends list and stay in touch If I get approved I will do the same.
Linda

ladysplenda

Sorry I am from Texas and Railroad but thought I might could help since Highmark was telling me the same thing.
Linda

piercedqt78

ladysplenda, they are not saying it isn't FDA approved, they are giving you a list of possible reasons that it is not covered and that is not the reason they don't cover it. They told me that the band did not have a high enough success rate for them to cover it. I sent them more recent data and they are changing the way it is evaluated in the system. Feel free to PM me if you have any questions, I am the one that got them to overturn the way they look at the band, I am the first one to be approved from Highmark BCBS ever. I realy put up a fight and I finally won. ~Mandy

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~Mandy
www.myspace.com/piercedqt78
weight: 242/160/145
Started in a size 22/24 now in a 11jr....woohoo!

Bandland, it's almost as great as Disney, only with no rides or characters.