Yes, Blue Cross Blue Shield Covers Lap Band Surgery
Posted by Lori on March 14, 2008
I think that’s the search I’m seeing turn up more than any other. At the Centennial Center For The Treatment For Obesity, they have the criteria for lap band treatment for Blue Cross/Blue Shield in Alabama, Arkansas, Federal Employees, California, Florida, Georgia, Texas, Anthem (Kentucky, Virginia, Wisconsin, Ohio), Empire, Missouri, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Jersey, North Carolina, New York, Pennsylvania, Independent Blue Cross Pennsylvania, South Carolina, Tennessee, State Of Tennessee Employees, Tennessee – St. Thomas and Baptist Hospital Employees, Regence (Washington), Mountain State (West Virginia), and Highmark (Pennsylvania). As well as CHA Health, United Healthcare, Aetna, Unicare, Medicare, Definity Health, Cigna, Humana, Humana Medicare Gold Choice, Healthspring PPO, Healthspring Medicare Plus, CHAMPVA – Tricare or Champus, Tricare Standard, First Health, TennCare Bluecare, TennCare Select, AmeriGroup, Tenncare Americhoice and Great West Healthcare.
And then they have this page which features comments from their patients about their experiences with their health insurance providers.
If this is one of the first websites you’ve been to and you’re trying to figure out if you qualify, the basic standard for most insurance companies is a BMI of 35 with co-morbidities (diabetes, high blood pressure, high cholesterol or sleep apnea), or a BMI of 40, and documented attempts at weight loss. And then each program will have their own little particulars. The criteria can change as well, so just take it as a guideline.
If you need to calculate your BMI, you can do so here. For instance, a guy who is 5′11″ and weights 275, would have a BMI of 38 – so he would need some co-morbidities to have it covered. His idea weight would be 165, so he could conservatively expect to lose 77 pounds. A woman who is 5′5″ and weighs 250 would have a BMI of 42 so she wouldn’t need the co-morbidities. Her ideal weight would be 138 and she could conservatively to lose 78 pounds with a lap band.
Sorry for the boring post. Just wanted to put it out there for all the link-a-phobics looking for quick answers.
Jenn said
Thank you for this. I am starting the process of lap band, beginning with an info session at Hershey Medical center on the 1st of April. I do not have any weight related health problems, aside from aggravated asthma, but my BMI is, sadly, over 40 – right around the 48 mark.
My insurance is BlueCross. I called them a few months ago and they assured me that they covered the surgery, but it’s always nice to hear the experiences of others with a particular insurance company!
That Fat Chick said
Hi! I have BlueCross, and I had it confirmed today that they do cover the lap band surgery. I wrote a blog post summarizing what was said to me; you can read it here:
http://www.thatfatchick.com/2008/03/19/you-should-see-the-smile-on-my-face/
Marsha said
I have BCBS and they covered mine as well. I had aggravating factors and a BMI of only 38. So I had to follwo the the guidlines for the DR and nutritionist. The dr office had it put all together correctly and they sen t my Pre author # the same day. I am 15 weeks out now down 44 lbs.
Angie said
I began my process a few weeks ago. I also have BCBS (TX). I have to wait six months before surgery with dr appt and nutritionist visits once a month till surgery. Did you have six month period also?
shauna phillips said
I have Blue Cross Blue Shield TN and they told me they do not cover it.
Cathy said
I have BCBS but they will not cover mine even with a doctor’s recommendation. Guess it depends on the plan.
SLY OF MD said
Hi,
I have Carefirst BlueCross (HMO) I was approved and have received my surgery date. It was a lot of leg work and my physician’s office gave me the information package and I had to do all the appointments and followup on my own, however, when I received my approval it was all worth it not to come up with $14 to 20k.
laurie said
Hello – I will be visiting with the weightloss center on 7/30.. This appt will involve diet, etc.. I will not see the surgeon until 10/1. I am praying that I get the entire thing going by the end of 1/09. I am 5ft 11 and 300lbs (this is the most I’ve ever weighed)I have come to terms that this is my solution !! My feet, knees and back are killing me. I had a hip replacement 2 years ago. I wish it could be done tomorrow. I am so ready for a change !
Sarah said
I have BCBS, which covers the surgery, however, my company’s policy specifically excludes the surgery. That wasn’t enough to stop me, so I received my surgery on June 19, 2008, self-pay. So far I am thrilled with the surgery, although I’ve only had one fill. 20 pounds lost, and only about 120 to go!
Kay said
Does anyone have BCBS of Michigan that has paid for Lap Band Surgery?
Kay said
Would you reccomend the surgery to others? Have you had any side effects?
Laurie said
I have BMI of 31.3 bt I had a heart attack at 42 and have since gain 70 pounds, do you think BCBS will cover my surgery. I am hoping that they will and with a doctors which I have. I have submitted all documentation to BCBS put am now in the waiting game…just looking for some inforation from people that have gone through this.
444Kathy444 said
Is there a good Doctor in Southern California that accepts Blue Sheild/Blue Cross for teen lap band surgery that anyone out there knows of?
Marek said
BCBS of SC Employee Health Plan does not cover any of the weight loss surgeries. If anyone find out something different let me know.
kelly said
Hi, I am 26 with Blue Cross HMO and will be getting Blue Cross PPO next month. I have a BMI of 41 and have been trying for almost a year to get the lap band surgery covered. Blue Cross keeps denying me. My doctor says if I switch to a PPO they will cover me. Does anyone know if this is fact? Has anyone had an HMO or PPO? How much will I have to pay out of pocket?
Libby said
I have BCBS PPO I want to get the lap band surgery, but my BMI is only 38
nadine cummings-kirk said
I read the blog saying that Blue Cross Blue Sheild pays for the Lap Band Surgery I live in West Virgina. My husband works for Massey Energy Coal Mines and in our insurance policy it states that our Blue Cross Blue Sheild does not pay for any weight loss programs or surgery is there something I can do to override this decision? Thank You
Eileen said
I actually have a PPO w/ BCBS and called them today. My plan apparently has an exclusion and doesn’t cover anything having to do with obesity. I’m really upset about it and want to appeal it. Best of luck to you. PPO’s tend to allow you to see more doctors, but I don’t know if they actually cover more.
matt said
so I am looking at taking a job just to get the insurance needed for this surgery, it is BCBS (tx) HMO. Anyone have any idea if that would be covered?
Barb said
I have BC/BS and am on a plan for teachers. It is a PPO plan as well. I called to ask the company if lapband surgery is covered, and they told me it isn’t–no obesity treatments are on the program I’m on. This sounds silly to me as they will end up paying a lot more for my high blood pressure & high cholesterol treatments, not to mention the heart surgery I will probably end up having since heart disease runs in my family & my sister just had triple bypass surgery done.
Valerianna said
Just want to know if BCBS Illinois cover for the LBS in FLorida…
spazzdout said
i have my husband bcbs ppo in alabama i dont know if they cover lap band i am afraid of the gastric bypass. i am always at work and dont have the time to call does anyone now if they cover it my husband works for the city of tuscaloosa. i hope they do if not the first siminar and blood tests alon will cost around fifteen hundred dollars
Lee said
I am with the Hemet Unified School Dist in So Cal….hs anyone done it through this employer and what DR. did you use?
Lisa said
I’ve got BCBS of NC, and they would only cover it if you had other health problems that a reduction in weight could rectify. I recently started having some kidney issues and then in February went from having very low blood pressure (norm for me) to very high blood pressure. They covered it, because it should make the high BP go away, and reduce the chances that my kidneys will fail in the next few years.
ALISA said
Does anyone know if BCBS of Mississippi pays for the lab band surgery?
Cassie said
Hi,
Has anyone in FL that has BCBS had the surgery? I have it through my husbands work….. please email me! cmdtl@aol.com