Insurance & Financing

Has anyone been on the Ins mandatory six months program called Healthy Roads? It is a telephone coaching program that you have to do before you are approved for the lapband.

Hi! I've been recently approved through Mail Handler's Insurance for the surgery. I was just wondering, since it's not mentioned in the brochure, if they pay for fills? Has anyone been approved under Mail Handlers? Thanks, Charlotte

I am new to this site, I am in the middle of my 6th months of dieting for the lapband. I just wanted to know if anyone from WI with badgercare Title 19 insurance has had the lapband approved? I keep getting all different answers, I have called many times, even the center that I am going to for the surgery gives me different answers, I am planning to have the lapband but if that falls threw I am thinking gastric bypass. Any info??

Does anyone have information on how much it will cost me after medicare pays there part. and they say first visit is $100.00 and co pay. I know my copay is $30.00 for specialist doctors and $15.00 for the reg. doctors, so how much will I need for the first appointment to see the Physic evaulation. Is there a copay for this, and do I see anyone else on this visit. I know they say it will take up to 4 hours of more. So any information will be so helpful. Thanks Lydia:paranoid

I've recently started new insurance Unitedhealthcare plan 100 a (whatever that means) A couple of my friends lap bands were approved with the insurance, they don't give you any crap. So I hope Iam lucky has they were. I was thinking about joining a diet clinic in the mean time but my husband thinks thats a waist of money (which it is). He is so for this lap band. Its nice to have a husband who is by my side, but he don't understand how long it takes to have the surgery. We live in Louisville Kentucky home of the Kentucky Derbry and my 1st goal is to loose weight by then(1st weekend in May) and I figured if I didn't get approved I could go that route. What do you think? Sh…

I currently have United health Care and by the grace of God all my Lap Band needs have been covered. I am on social security disability and in Febuary finaly qualify for Medicare. My question is....does anyone else have Medicare and does it cover care associated with your band? Thanks alot!

Does anyone know what the diagnosis code is??? thanks

:help: :help: I just had lap band surgery on 12-29-06, and am doing well. I am researching options for my sister in Ohio, who has Kaiser (HMO) and medicare. According to her- Kaiser only covers Gastric Bypass, and not Lap Band. SHE DOES NOT want to have such a drastic surgery at her age. She is 67 yrs old. She is desperate to lose weight and will consider Lap Band if she can get approval through Kaiser. She can't afford to self-pay. She has diabetes, hypertension and arthritis. Has anyone ever had Lap Band at a referral facility through KAISER? It seems to me that since lapband is safer that they would be willing to authorize it through another facility, especially si…

I am so :angry ! I started checking into a band for my mom...... I helped her set up a profile, and then I downloaded her Health Certificate... guess what is on EXCLUSION #33? You guessed it.. 33. For bariatric surgery, regardless of the purpose it is proposed or performed. This includes but is not limited to Roux-en-Y (RNY), Laparoscopic gastric bypass surgery or other gastric bypass surgery (surgical procedures that reduce stomach capacity and divert partially digested food from the duodenum to the jejunum, the section of the small intestine extending from the duodenum), or Gastroplasty, (surgical Certificate procedures that decrease the size of the stomach)…

If the WLS was covered by your insurance will the fills be so also? Does anyone have the code for a fill? I have Aetna.

has anyone had any experience dealing with medical mutual, or medical mutual super med plus?

Hello, Does anyone have Medical Mutual and know about all the hoops I am going to be put through. I read a few people's threads saying it was difficult but I was wondering if anyone would know. I'm 20 years old (in about 2 weeks) , I'm 5'7"-5'8" and my BMI is 49...which is basically way over the requirement. I've been going to the same doctor since I was about 2 years old so he has ALL of my records. I've went through dieting, in high school i played sports, i was one WW for about 3 months until it failed.....if i showed all of my records to Medical Mutual (since i've be obese for way over 5 year and the records will prove it) and show proof of my attempts with WW .…

Hi, I have Cigna Insurance and they require me to be involved in a six month physician supervised weight loss program prior to approval for surgery. How have others handled this? This is so foolish but mandatory. Thanks. Jan

:omg: i remember talking to a few of you re: bcbs anthem-if you want a lapband, you must have a bmi above 40, but below 50. i saw it somewhere and couldn't remember where i saw it....and here it is...right in the policy... BMI of 40 or greater, or BMI of 35 or greater with co-morbid conditions including, but not limited to, life threatening cardio-pulmonary problems (severe sleep apnea, Pickwickian syndrome and obesity related cardiomyopathy), severe diabetes mellitus, cardiovascular disease or hypertension. AND *Note: Individuals considering the laparoscopic adjustable gastric banding (Lap-Band®) procedure must meet the above minimum BMI requirement and, in addition,…

Ok, so I had my first seminar yesterday and because I had been to one about 6 months ago, I knew what to expect. There were about 150 folks in the room and there were no seats, people standing and sitting on the floor, it was PACKED. Kids running around, people fighting over surveys, because there was only a few. It was a mad house........................ So, they proceeded to tell us what their requirements were, meaning the hospital requirements. They are as follows Meeting with the nutritionist Psych Eval Loose 10 pounds And no less than 2 additional seminars, so yesterday was seminar 1 and they only hold them once a month so I have to wait another 2 months …

I self-paid for the lapband because my medical coverage through the military and my employer's insurance excluded the procedure. Since that time, my husband was picked up for civil service with the Air Force and we have an opportunity to at least get some insurance that will cover any unforseen future lapband expenses. If you're a civil service employee who had the lapband procedure covered through your civil service medical insurance plan, would you please share who your insurance carrier is? I'm hoping that I'll be able to locate and research the carrier quickly so my husband can initiate coverage.

:help: I and currently looking to hire an attorney to help me get my health back I have stomach prolaspe and need to have band removed and stomach repaired for from the damage and insurance has denied anything to do with this due to the band being the cause. I don't beleive this is legal it can cause other health problems has any had to fight this with an attorney or any tips I sure could use the help that Lori:help:

i just got off the phone with a rep of my insurance. Plus I had him fax me everything he had on the precert. I have found out that I have to be on a medical supervised diet for a year or more preceding the surgery. :faint: My BMI is well over 40, diabetic, lower back pain, joint pains. I wondering if anyone has any experience with this insurance and how strick they are about being on diet for a year. I don't want to wait a year to get this done.

Anyone know if they are covering the procedure? Cb

I am so excited. I have Tufts insurance and I can't believe how fast I got my approval. I just finished all my tests and paperwork for my surgeon and they submitted it and two days later I found out I was approved. How great is that. I was looking for a fight because on one of my visits my BMI was below 40(didn't wear my heavy jeans that day). My surgery date is March 26th. Seems far away, but I bet the time will just fly by. I'm just excited that I don't have to pay a cent for the surgery. I love Tufts:) :huggie: I'm sure I'll have more questions for you almighty great ones when the date gets closer. Wendy

I was told by my insurance agent (broker) that BC/BS HMO Small Groups would not cover lap banding. In my benefits book under exclusions is the line, " Any treatment, drug, procedure etc. for weight control/ obesity... is not covered". Has anyone on a small group plan ( 50 employees or less) been covered in Texas?

Does anyone know about large groups? with United Health Care? If so what was your experiece?

I just called the insurance company and they said that they hadn't gotten any of my paperwork! This sucks! Everything goes smoothly until you get a deadline, and that is when everything starts to stall.

How quickly were you approved by your insurance? My paperwork was sent to insurance today and my contact at the surgeon's office said to start calling the insurance company around the middle of next week. Could I be approved that quickly?

an "insurance" for lapband? My surgery date is Jan 18 but am losing my insurance Feb 28, 2007...so, I am really worried about something bad happening and not having insurance to fix it. My doctor mentioned some type of insurance that will cover complications. He is supposed to find out more info for me but I want to know ASAP. Has anyone heard of this and can you PLEASE guide me in the right direction?! Thanks!!!

I'm wondering how the insurance company will react when I tell them that the Primary Care doctor I am going to only has 3 yrs of my weight history. I know that one of the qualifications is that I need 5 yrs of proof of being overweight. I didn't have any doctor before this....I only went to walk in clinics when I was sick. I have been over weight since 3rd grade and have the pics to prove it if they want them. Should I be worried?

I was trying to find out what insurance i should get ? anyone know what insurance is going to cover lap band my bmi is 40 but i dont have any other health problems yet . HELP ...............

I had to switch my insurance in November (something about our zip code). I went with Mutual of Omaha. I sent them my paperwork the Tuesday before Thanksgiving and I got a call last friday the 8. I can't believe how fast they were. I had been fighting BCBS since April. I don't even have my insurance card yet. I hope to be able to make an appointment for mid to late Janurary.

Hi, Does anyone know if there is a way to get your insurance to cover your fills? I live in NC and I am planning on going to CO for surgery. I was wondering if anyone self-paid for surgery, but was able to get fills covered.......What is the best way to find out if I can? Should I call the insurance company (UHC) and just ask? Or should I contact the doctor's office first for information? I have contacted a lot of doctors around here about fills and they are all really expensive. I considered flying back and forth to CO, which may be cheaper than get the fills done here. I just think this may get complicated. What it I was overfilled and I had already gone home? I would…

I tell you...based on some of the experiences on this board I decided to be proactive and start getting my medical records together. Whoo'...why do I feel like an investigator? Good knowledge though...I now know that if I ever leave a doctor to ask for copies of my medical records.

When I call the insurance company next week and start "gently harassing them" (the surgery center's advice) to see if I have been approved, who should I talk to?

Hi everyone those of you who have Cigna Insurance and have to particpate in a six month physician supervised weight loss program, Did Cigna pay your PCP visits or did you have to pay out of pocket? Jan

Hello everyone I'm sure some of you are familiar with some of my threads, like the one last week were I said I had about given up. Well great news today I was told by my insurance today that I was elligable to go through with the lap band surgery, well I'm an ol country boy so I said "So by elligable you mean approved rite?" And he said yes I was aproved and I could go ahead and make preperations to have the lap band procedure, its been a long stugle but finally here I am. Time for band land lol. My first info was submitted to insurance in august so hang in there all you who are waiting and good luck!

I was simply searching Blue Crosses website and found this! http://www.bcbs.com/betterknowledge/tec/press/ Technology Evaluation Center in the Press November 2006 The following Assessments and Special Reports were acted on at the November 2, 2006, Blue Cross and Blue Shield Association Medical Advisory Panel (MAP) meeting: Laparoscopic Adjustable Gastric Banding for Morbid Obesity The MAP concluded that laparoscopic adjustable gastric banding for morbid obesity meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a compre…

i was wanting to know if there is anyone out there that has been denied through united healthcare but their appeals were successfull? back in november when calling to find out my benifits 3 different times i talked to different people ( with united healthcare), they said lap band was covered as long as i had a predetermination letter. when i went to see the doctor, he said i was a perfect candidate for the lap band. when i talked to the insurance coordinator for the doctor, she said that since they said that and united healthcare was so good about approving it, she said i have 100% chance of getting it. we just had to wait for the final approval letter before we could sta…

I live in Louisville Kentucky and have Humana HMO KPPA insurance and they require the 6 month diet. I called them and they said the Doc has to send the paperwork to the insurance company. I told them I started the diet in November and would that count, of course she didn't understand me so Iam just going to talk to my pcp and se what we can do to speed up process. My husband is taking a buyout at his job (Ford Motor Co) and once he quits they will give him 6 months of free insurance, so Iam trying to get everything approved before then. I met this lady today who had a triple heart bypass and she had humana hmo and they declined her surgery. I think thats crazy because her…

Hi there! Anyone get approved for lap band with this insurance? What were the requirements? Thanks so much. I'm new at this!!! Vanaz

Hello Im hoping to hear of your experiences with Anthem BC/BS NH. I called the ins company and they said it was covered. Could it be that easy?

Hello, Anyone know how hard/easy to deal with Tufts Navigator PPO insurance for getting the Lapband procedure? Thanks in advance!

i have never filed a claim fir the lapband with my insurance company because i was told my policy doesn't cover any thing dealing with obesity, but i have a letter of medical necessity. do you think i should file a claim or is it a waste of time?:help:

I have been denied. bcbs ma. my bmi was 37.5 directly after 6 mo of supervised diet. and on its way back up.. I really thought I would get my band soon... now I am starting an appeal process.. my dr.office sending me papers to fill out .. they have an atty that works for my case no extra charge.. I am nervous.. I have asthma, my blood pressure keeps climbing , ostieoarthritis in both knees... If those arent co-morbidites.. it is just a matter of time.. feeling full is my secret shame.. (no so secret to look at me) but I don't know whats ahead .. any wisdom out there friends.. thanks myturnow...donnaco

:help: :help: ANYONE HAVE CIGNA OR WHO CAN TELL ME HOW HARD IT IS TO GET APPROVE.....I AM THINKING ABOUT GOING TO DR CURRY AT DEACONESS..BUT I AM CONFUSED ON WHY WE HAVE TO PAY FOR A PROGRAM FEE IF OUR PRIMARY CARE DR IS WILLING TO SUBMIT PAPERWORK TO GIVE IT APPROVED.....DO ANYONE ELSE KNOW OF ANY OTHER GOOD DR'S IN OHIO??????

I have been researching this site and reading alot about insurance and exclusions(which my company has), pertaining to WLS. One of the posts I read was that someone had gotten their own insurance through Mutual of Omaha and got approved. That sounds so promising, but is it the thing I should consider to avoid appealing and other hoops to jump through. I started taking growth hormone shots over a month ago and at first my insurance said no way. It was only covered for children. Well, my endo said it was very weird that the insurance called her and said no, then a few minutes later called again and said yes...what is up with that? lol I was thinking or hoping they woul…

Hey everyone, I started a new job a week ago, and they carry United Healthcare. They exclude weight loss surgery on the plan, BUT they are renewing the plan next week, and discussing the renewal today with the insurance rep. My HR guy was nice enough to ask about adding that option to our plan, he's sympathetic because his wife wants to get banded. I don't know if it costs the company more money to cover this or not. Does anyone know, or has anyone else had to request getting it added to their employer's plan?

Hello all and Happy New Year! :clap2: Has anyone been approved by Regence? Sure would like to know. I have been "dealing" :angry with them for quite awhile now. Hope to hear some feedback! Thanks

well, yesterday i finally faxed my bariatric clinic my new insurance card that will be effective 1/1/07....so i asked her what else i can do, and she said i just have to wait. isn't this my first shot at an approval? isn't this when i should be sending copies of my ww books, and all my other attempts at weight loss? i'm just worried that i'm not doing enough. i'm not the type to just sit back and wait...any suggestions?

Hey everyone well I had my seminar back in August and now in December I still haven't heard anything from my insurance which is bcbs of new jersey its really a discouraging situation waiting all this time. I mean hell I would just like to know yes or no, so I can stop worrying myself to death about it. I mean I went from being really anxious and excited to just totaly fed up and don't really care anymore. I dunno how everyone else feels while waiting but thats how I feel.

Hi, I have just recently found out about the banding procedure and started doing research. I am 28 years old and have struggled with my weight all my life. My major concern is my insurance company covering the procedure. I have struggled with my weight all my life and luckily I have the same primary care doctor for the last 10 years or so. The only thing that I am worried about is that I do have Hypothyroidism. It uncontrolled and a large part of that is because of my weight. Do you think my thyroid disorder will cause a problem with my insurance company covering the band procedure? Thanks for the help

Just a quick announcement, if you visit our new website, http://obesitylawyers.squarespace.com/ You'll see an area for journaling. In addition to adding documents, research reports and sample appeals, we're also adding podcasts and videocasts. These will be topical and focus on appeals, denials, as well as nutrition, exercise. We have interviews scheduled with three bariatric surgeons, a personal trainner and nutritionist, as well as clients and patients alike. All free to give you a better understanding of these areas. Be well. Gary Viscio www.obesitylawyers.com

Hi Friends, I am starting my second month in the ins 6 month mandatory diet program. I am going to be as truthful as I know how. Knowing that I have 5 months left, I am finding myself eating more and not caring because I am assured that I will get the band after the six months. Maybe I don't fully understand what the six month telephone diet program is for. I am so excited to get the band that I can hardly concentrate on the weight loss counsler and all of the healthy tips that I have heard time and time again. I know whats healthy but I need a physical restrictive implanted reminder not a reminder from a one a week telephone call with a nice lady telling me to just eat…