Love My Lap Band!

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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. They add new companies as they get them so I might not have all of them listed. Scroll to the bottom of the page, and you will see a PDF link for every company they cover.

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 at the bottom of the page. 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 ideal 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.

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66 Responses to “Yes, Blue Cross Blue Shield Covers Lap Band Surgery”

  1. 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!

  2. 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/

    • Lori said

      Hey, it’s a treat to see you on my blog. I’m glad to see that things are coming along for you. You’re one of the first people I put on the blog roll. I’m going to be eager to hear your story.

      • My story is two weeks shy of taking an exciting turn! My surgery date is November 18th, 2009. *However*, I’ll be having gastric bypass, not the band as I originally planned on.

  3. 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.

  4. 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?

  5. I have Blue Cross Blue Shield TN and they told me they do not cover it.

  6. Cathy said

    I have BCBS but they will not cover mine even with a doctor’s recommendation. Guess it depends on the plan.

  7. 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.

  8. 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 !

  9. 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!

  10. Kay said

    Does anyone have BCBS of Michigan that has paid for Lap Band Surgery?

  11. Kay said

    Would you reccomend the surgery to others? Have you had any side effects?

  12. 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.

  13. 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?

  14. 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.

  15. 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?

  16. Libby said

    I have BCBS PPO I want to get the lap band surgery, but my BMI is only 38

  17. 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

  18. 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.

  19. 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?

  20. 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.

  21. Valerianna said

    Just want to know if BCBS Illinois cover for the LBS in FLorida…

    • melissa said

      we have bcbs of illinois and we live in georgia. If you find out that bcbs of illinois covers it, please let me know!
      Melissa
      babblefish1967@aol.com

      • Lori said

        Melissa,

        Call your provider and ask. There is a fairly good chance that they do. They’ll usually want you to have proof of having been on a medically supervised diet and if you’re not too overweight, to have other complications. So, be prepared for that and don’t sweat the six month diet, if that’s what you have to do. It’s worth it. The number of people I talk to who don’t love their Lap Band is almost non-existent. If they turn you down, then call Walter Lindstrom at the Obesity Legal and Advocacy Center that I have listed as Legal Help For Insurance Issues under Websites, on the right.

        Best of luck. i hope you get your surgery soon.

  22. 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

  23. 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?

  24. 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.

  25. ALISA said

    Does anyone know if BCBS of Mississippi pays for the lab band surgery?

  26. 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

  27. melissa said

    Hi, I am in the beginning process of trying to get my lap band surgery covered. I live in CT and have Aetna PPO. I called them and they said they do not cover it. Does anyone else live in CT and has had success with their insurance company. If so can you you give me any information? Thanks!

  28. michelle said

    i am a united healthcare employee and have been informed that any obesity related treatment is explicity excluded from the healthplan. does anyone know if there is some kind of medical finance company that might offer a loan?

  29. MayLou said

    If you call your insurance and they tell you it does not cover don’t give up because that happened to me but when I went to the Free Seminar for Lap Band they called my insurance and they said it DOES cover.

  30. elise said

    BMI 36.6, high blood pressure, depression, fatigue, dry skin….
    GHI BCBS with the NYPD….anyone know if there are prerequisites for the surgery? my PCG wants me to have it.

    • Lori said

      Elise,

      One more comorbidity would be a common request at your BMI. Either sleep apnea, diabetes or some kind of heart disease. But if your primary caregiver is pushing for it, that should help. I’m not sure where they rank depression in there. Anyway, if all else fails, there is always Mexico. Lots and lots of professional people, whose insurance will not cover their surgery, go south of the border for the procedure. Dr. Ortiz, who is doing my surgery, will frequently have a nurse from a particular hospital as a patient and will then then see a steady stream of nurses and physicians from the same hospital come through. Don’t let people scare you about surgery in Mexico – the facilities are built to American standards to bring Americans customers to their doors. They are sparkling clean and beautifully run. If people are going to get on you about going there, then don’t tell them what you are doing. Just go do it. Those nurses and doctors can have surgery anywhere and they go to Mexico because of the level of expertise. Ortiz has done over 6000 Lap Bands himself, and no one in the US has that kind of experience. You can find some clips of him and of his patients on YouTube. You’ll be impressed.

      Best of luck however you go.

      • Selina said

        My BMI is only 37 but I have high blood pressure, diabetes, heart disease, and depression in my family. I personally think I have a heart problem and am very depressed. I stay tired a lot also. I know if I got the weight off, I would feel like I could run a marathon and just might do it…LOL

        I am not sure that with these problems, they will take me as a patient either.

  31. Holly said

    Hey Elize, I am in the same boat like you, ghi w/bcbs nypd….bmi of 36, and hypertension. I just submitted all the paper work to the weight loss center. They will be submitting everything to the insurance company on Monday so hopefully I get the approval SOON. How far along are you in the process???

    • Kirsten said

      have u heard anything back from the insurance company? do you have federal blue cross blue shield? i have bmi 36 with high blood pressure, gerd, depression and am waiting sleep apnea visit. good luck

      • Kirsten said

        did you end up getting approved for surgery? i have bmi 36.6, high blood pressure, gerd, sleep apnea. my paperwork was just submitted to fed blue cross blue shield. very nervous since low bmi.
        any info would greatly be appreciated,
        Kirsten

        p.s. cool name- dont hear it very often :)

  32. elise said

    Thanks for the info Lori. And Holly….not far into this AT ALL!there is such a wait to see the Lap Band Doctor…I wont see him til 9/30….

    The Lap Band Doctor i am using is Dr. Holover (??). works wit Dr. Garbar. Anyway, the office told me GHI usually wants 6 mos. of diet/exercise…supervised…before surgery. MY PCG said he knows of a few that the surgery at 3 months. I so do not want to wait that long. What happens if in the time u lose enuf weight that your BMI doesnt qualify you? No surgery then? Then ya gain the wieght back? what is the process u had to do with the Weight Loss Center? and please keep me posted! cant wait to her your news on monday!!Is your husband NYPD? Mine is….I live on LI…cool that we have so much in common! lol.

    • Holly said

      Hey Elise, if you don’t mind trooping to the city you might get seen a bit faster call 212-305-4000…also you can do the seminar online @ http://www.obesitymd.org, you have to have the seminar certificate # before you call It’s real quick only takes about 2 hours. If you haven’t does so start going to your doctor now for the supervised visits. When they submitt all the paper work they submit your fist weigh in. now keep in mind your office visits have to reflex the high weight. Talk to your doctor I am sure he/she is willing to work a few thing out ;-)….just get the ball rolling. Wish I could send you a private message with more info but I really don’t know how to work this site…sorry

  33. Band-it-Damn-it said

    Wow Holly seems like you really have your stuff together!

  34. Rebecca said

    Help. I am new at this. I just signed up for Blue Cross PPO. I am a teacher and 100 lbs over wt. I gained my weight when I started teaching, as opposed to waitressing etc. In any case, I hope I signed on to the correct ins. because it is costing 6oo plus from my income and benefits. I will pay four dollars plus out of pocket. Who should I go to? I had a c-section when my daughter was born, not so good; staples were taken out to soon, had an inhfection, etc. Things are somewhat okay. Need best surgery repution. Want to lose weight, and be alive to enjoy new wt loss.

  35. Dorian said

    I have Blue Cross Blue chield of Kansas city and I can tell you now that they do not cover this expense. Nomatter what my doctor says, I’d have to come out of pocket for something that could in essence save my life. I’ve been dieting and trying to lose the weght ever since I had my back surgery. Nothing seems to work. changing my eating habits walking, running, Slim 4 Life, nothing is helping.

    • Lori said

      Have your doctor contact Allergan. They help their patients file denial of service appeals with insurance companies. On the right side of the page is a link to a blog post about what to do if your insurance turns you down. Read the post and take that course of action.

      If you still can’t get it approved, then take a look at Mexico. I’m having my surgery this week with Dr. Ariel Ortiz, who has done more Lap Band surgeries than any doctor in the US. In Mexico, it will cost less than $10k and you’ll get state of the art care in a beautiful facility.

      As to your problems losing weight, most weight gain is genetic in origin. You can’t lose it. Every time you start to lose weight, your body goes to war with the weight loss. It starts feeding you chemicals that make you incredibly hungry while cranking down your metabolism so that you hang on to the calories that you do eat. Over 98% of weight lost on a medically supervised diet is regained.

      IOW, you’re perfectly normal. And weight loss surgery is the only way you will be able to alter the equation.

  36. Melissa Harris said

    I work for the state of GA and have UHC PPO, the insurance company states they won’t cover lapband surgery or any other weight loss surgery. Anyone else have this coverage and fought the insuance company. BMI is 53.

  37. Roman said

    Hi I was wondering if Anthem Blue Cross HMO covers lap band, I am 27 with Diabetes since i was 7 yrs old, high blood pressure, asthma, and high cholesterol, and had a heart attack at 24 do you think they will deny me?? Please reply back..This is the only hope I have to loose weight..

    • Lori said

      Dear Roman,

      I think you stand a very good chance of getting the surgery approved. In your case, they may well want to guide you towards a gastric bypass, but make your own decisions about that. The GP is more profitable for them and riskier for you. If they fail to approve you, click the link on the right hand side of my page about insurance denials. There is a law firm in California that specializes in contesting insurance denials of claim for weight loss surgery and they work with Allergan, the makers of the Lap Band, to help patients fight for the procedure. Check out http://www.obesitylaw.com to see the law firm.

      Best of luck. Drop back in and let us know how it goes. And if you have any more questions, don’t hesitate to ask.

      • Roman said

        Hello is me Roman again!! i am finished with a 6 month nutrition program my doctor put me through, i was wondering does this mean i am in the process of getting the lap band?? i still have not heard from the insurance company yet, just wondering if anyone else has gone though this?? what happens next?? pls someone reply..thanks by the way i have anthem blue cross HMO so was wondering if they cover this procedure as well??

  38. Jessica said

    Hello. I am just starting the process of hopefully getting the LBS. My doctor faxed a referral to the local surgeon on Friday, the Surgeons office called me today to get a spot reserved at a seminar. I called my insurance company, Blue Cross Blue Shield of Illinois (I work in Indiana, live in Ohio)they said that my company does NOT exclude the surgery (YAY!) but I have to fit all kinds of criteria. The rep from BCBS is going to mail me the list but I tried to jot it down as she spoke. One thing that troubled me is that she said was they need 24 months of diet history with results. Does that mean they need doctors records for the past 2 years? I went to my doctor about a year ago to start a weight loss plan where they took my weight and everything but, unfortunately, I never followed up. I was hoping they just wanted a record of what I’ve done in the past 24 months to try to lose weight but that seems a little too good to be true. Any advise?

    • Lori said

      Insurance companies will try and delay hoping that you switch companies or change your mind. So, they may very well put demands on you to attempt weight loss first without surgery. You may just have to go along with that but it’s unlikely that they’ll put you off for the full 24 months. A lot of people – health professionals, in particular – elect to go to Mexico rather than wait for surgery. If they deny your claim based on a lack of diet history, get started on the diet and ask your doctor to contact Allergan (the manufacturer) for their assistance in appealing the denial. Walter Lindstrom, of Obesity Law, has teamed up with Allergan to help patients appeal. If that fails, and you don’t want to wait, think about Mexico with its world class facilities and their doctors who have been doing Lap Bands longer than anyone in the US. Dr. Ariel Ortiz did my surgery and his place and staff are fabulously professional and everyone speaks English. Physicians from all over the US come to Ortiz because he’s one of the guys that Allergan has train doctors on the procedure. You couldn’t be in safer hands. And it will only cost $8k.

      Good luck. This procedure has changed my life. I hope you get it sooner rather than later. But later is definitely better than never. It took me two years to be able to have the surgery and I’m just glad I got it. It was worth the wait.

  39. lynette said

    Anyone have a doctor in the Atlanta, GA area they would suggest?
    thanks!!!

  40. Ali said

    I have Federal BCBS California (HMO).

    Appointment with PCP/Blood Tests 3/29 results: PCP stated he would recommened; mildly high blood pressure (130/80), Blood sugar ‘normal’, stated that liver enzymes were elevated and I am insulin resistant.

    Height 5 6’1/2, weight 275 (BMI 44). 27 years old (female)

    can the PCP make a direct referral to BCBS for the surgery or does he refer me to a surgeon who then makes the referral? Any similar stories to mine that have approval timelines? Brochure states BMI over 40 or BMI over 35 with co-morbidities…. should I be an easy approval?

    Please let me know any insights y’all have

  41. Vicki C. Morgan said

    Wt: 167
    Ht: 5’3″
    BMI?

  42. TARRIE said

    HELLO,MY DOCTOR JUST SUBMITTED MY INFORMATION TO BCBS OF ILL.IS THERE ANYONE CAN GIVE ME INFORMATION ON THE WAIT. IM PRAYING I WILL NOT BE DENIED.

  43. D said

    Does anyone know if the lapband is covered by Independence Blue Cross…the PPO Program…in Washington?
    I am going to call Monday to see if they cover it for sure then make an appt with my doctor!!!
    I am so so tired of being over weight!!!

    Thank you for any comments for an answer to my question!!!
    D

  44. karen said

    Does anyone know if BCBS of La pays for lapband surgery?

  45. Ashley said

    I have BCBS Federal Insurance (work for the government).
    My BMI is over 40, but I have no other related problems.

    BCBS covers my surgery, and no 6 month diet period is required.
    They are super fast so far with the process…

    A heads up, if you are doing the surgery in 2011, you will need 2 years prior doctors records stating your BMI was over 40. Annoying-so I’m having mine done in December.

    Love my insurance!!!!!!!!!!

  46. Serena said

    Does anyone know if BlueCross BlueShield Health Select State insurance of Texas pay for this surgery?

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