Are they for us or not! (I have BCBS of North Carolina)

Hey Guys, I'm feelin really bummed today . I decided to get the LAP-BAND®, I went to the orientation here in Fayetteville, NC and completed all the required paperwork. My doctor was even in my corner, she completed all documents needed and wrote a letter of recommendation stating that my BP is elevating due to weight gain, it's not quite high yet, but due to the weight gain it is elevating. On the paperwork it has that my BMI is a 40 for approx 4 out of the 5 years, but based on the surgeons office that I was going to go to the insurance person for that office said it wasn't good enough, and that my insurance co wouldn't approve it because based on their scales my bmi is only 39.8. That really sucks, I did everything they asked and she wouldn't even give me an appt to see the surgeon. Now, I'm sort of scared to try another surgeon as I may get turned down again. I am scheduled to go to Duke for the orientation. Anybody had any experience as such that can give me a litte advice. Thanks

I went to a consultation at a surgeon's office and they told me that because I had a HMO that they would not even cover the LAP-BAND®. So I was upset but I decided to call my insurance co. and have them look up my policy and they told me that they will cover it as long as my PCP says it's a medical necessity. They don't require any classes or weight loss beforehand. So my PCP gave me a referral and it was approved in 2 days. So if I where you I would call my insurance before talking to anyone else and ask if it is covered and what is recommended that you do before you can have the surgery.

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Thread Starter

Thanks. I know that my insurance covers lapbands with a bmi of 40+ and less than 50. I printed out the policy, and I have a friend who has bcbs of NC and had this procedure done. That's who recommended me. Do you have a surgery date set yet? Good luck to you and I wish you wll.

Thread Starter

Well being that said, you guys I guess it all depends on where you go. I was referred to Duke after Pinehurst wouldn't even allow me an appt with their Doc saying my BMI was below 40 and it would basically be a waste of there time. Well, I'm through the final stages of my journey of getting the surgery done. I'm just waiting on insurance approval, Duke has a really great team and they don't mind working. I really appreciate them. Just keep me in your prayers that I get approved. I don't know why I wouldn't my BMI was just a little over 40 and I have high blood pressure, but I am not taking meds for it as of right now. I'm hoping that when I lose this weight I won't even need BP meds. Well I'll keep those informed that want to know what's going on.