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.
March 14, 2008 at 11:23 pm
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!
March 19, 2008 at 1:20 pm
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/
May 8, 2008 at 11:13 am
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.
May 19, 2008 at 8:10 am
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?