Insurance & Financing

I posted Angry and frustrated in Toledo. I am new to this site. I have Paramont insurance in Ohio. They recently signed a contract w/Dr. Duckett to pay for lap band surgery. Currently it is excluded from my company insurance policy. (It seems mainly because Paramont was not includiing it is any policies). Can people please share any experience they have had in getting their company to add the surgery to their policy once the insurance has made it an approved procedure. Any advice on what to do? I have access to letters from PCP and cardilogist plus therapist indicating that the procedure is medically necessary. I plan to present these to my employer. Anything else…

I have Cigna insurance. Did anyone else have a problem getting approval? I have been through 2 denials, but still hopeful. I have met all the requirements they have asked for including 6 months under a doctor's care in weight management. In November my doc is resubmitting everything to try again. 3rd times a charm right???? Any suggestions??

I realize that it's not the insurance company, but the employer that is the last word on what is covered, but has anybody here had PacificCare PPO and what was your experience? I started with a new employer in April and haven't explored my options...plus mine would be for a rebanding. Not sure if that makes a difference or not because everything is gone except for some tiny little scars. I was told I could get rebanded in 4-6 months. Not quite there yet, but wondering. I really miss my band.

Tom Petty had it right when he said "the waiting is the hardest part." I just joined this group and have mostly stayed in the general discussion forum. Everyone there has been so helpful with answering all of my questions, but I can't help but envy them all. It seems like the waiting will be forever - I can't even get in to see my PCP until the end of the month! After that, heaven only knows how long it will take to get the paperwork submitted. And though I'm trying to keep a positive attitude, I can't help but think I'm going to be denied or they'll tell me I have to do a diet for two years or something. More waiting. Ugh. And if - after years of carrying around an…

Great news!! As of 5/20/05, Anthem BC/BS now covers the Lap-Band System as a medically necessary weight loss option! My surgery was originally denied and my surgeon did an appeal. The appeal was approved, and I found out that they added the Lap-Band to their obesity surgery policy. I had the procedure on 9/21/05, and as of this morning I have lost 17 pounds! Hang in there - I think the other insurances will be quick to follow. Anthem Obesity Surgery Policy.pdf

I just wanted to know if anyone with Pacificare (HMO) has had the lap band surgery approved through this insurance. I called them and was told that only the RNY and the vertical banding are covered. I was just wondering if anyone has been successful in having them cover the band even though they say they do not.

I have Medicare as my insurance. They covered my surgery and now I want to see if they cover fills. Does anyone know the CPT code for fills? One that they have used and it was covered. Anyone with Medicare been able to get the fills paid for? Any help would be greatly appreciated. Thank you. Stephanie

Hello everyone...anyone...lol...: Has anyone used, or know of anybody that used the OBESITYLAW.COM for an appeal to their insurance company? thanks!

Hello, this is my first time here. I just learned about this site via obesityhelp. I've posted this on OH, however, obviuosly no one has any experience with Beechstreet Insurance. Has anyone here been banded via Beechstreet? I would just like to know how difficult they are and what hurdles you have to jump? Thanks for you time! Crystal

I am going to be living with one of my two daughters, but wanted to see whether either state, North Carolina or Maryland, approved LapBand bariatric surgery. Thank you OneMoreTime

my insurance policy has exclusions concerning the treament of obestity . i have ky anthem blue access ppo. has anyone been able to get them to pay? i'am 40 and morbid obese.

Does anyone know if Tricare Prime covers fills?

Does anyone have any experience with Life Insurance companies in relation to the Lap-Band? Do they view it as a good thing? Will having it done lower my premium? Or do they view it as a potential risk? Since common sense & logic does not always prevail in these sorts of things, anyone direct experience with this please share... THANKS

Well my insurance says they pay for the morbidly obese to have lap band but I'm beginning to wonder. They first said all I had to do was go on a 3-month diet that I would be on after the surgery. I did and we covered all the basis - nutritionist and md supervised. So they sent in the letter but the PA signed for it because Texas accepts PA in the same manner that it accepts MDs. That was denied and they told the doctor's it had to have the MD signature. The person told the surgeons staff that if they get the letter with the nutritionist, pa and md signature it would be approved. Wrong - denied not medically necessary. Does anybody have a well written app…

I was reading my plan documents for united healthcare and it says under exclusions.... "Health service and associated expenses for the surgical treatment and non-surgical, medical treatment of obesity (including morbid obesity) are excluded." Does anyone know a way around this? Thanks, Kerry

I went to see Doc on Sept 1. Now I am waiting for insurance to find out if I am approved or not and the waiting is pure torture. I hate the fact that my life is in the hands of someone else. How do I pass the time? Eeeeks I never thought this would be so tough.

Hi everyone; I am working on plan B ..since I was turned down by BCBS Illinois. I was wondering, has anyone maybe found a private insurance that is ok with pre-existing conditions, that might cover Lap band?..just a thought..grasping here.... thanks cathy BMI 52 wt 333 lbs... goal 160 lbs trying and waiting.....

has anyone had to get approval from Tufts health plan? how hard was it?

I have been awaiting approval from BCBS Illinois, for about 5 weeks. I found out today that I was turned down, because I do not have a documented full year of going to a physician for weight loss. I am so disappointed. I was on Phen-Phen yrs ago for about 6 months, was told that was too old....I have been on every diet since that time, that anyone can imagine..including hypnosis! I am sure many of you can relate. I have only just recently ( 2 months) been diagnosed with hypertension. I have had a hip replacement, and was told I may need another one and also a knee replacement...needless to say it is hard to excercise with 100 lbs of extra weight. Anyways, I felt li…

What does anybody know about coventry of kansas regarding coverage of the lap band?? Thanks for your help

Hey Guys just wondering if you are not successful with the band can you get the gastric bypass?

Hi all, I have my consult with the surgeon on Thusday. (I am so excited!!) Any way I have been looking and have noone here with this Ins. So I thought I would ask. Does anyone here have BCBS NEIHBP (Blue Cross Blue Shield National Industry Health Benifit Plan)? Are they quick to approve? Did you experience any problems? Any advice? ANy help from anyone would be greatly appreciated. Just waiting and hoping. Everything has gone so smoothly for me I have this terrible feeling that will soon go wrong. Beth

OK folks - You may or may not have seen reply posts from me regarding the evil insurance company - Blue Cross. I called prior to starting the pre-work for the band to be sure that there was no company exclusion - and was told that there was not. When my Lap-Band coordinator called, SHE was told that there was. GRRR. OK - the point of this post? It's all in HOW you ask the question. The following is an excerpt from the e-mail I got from Blue Cross of CA: "I've looked into the ... contract further and their is an exclusion but their isn't. Please see below explanation. I think the customer service rep the provider spoke to didn't go into enough detail o…

I just called my insurance carrier (Pacificare HMO) and found out that they cover RNY and vertical banding, but NOT the lap band. I haven't heard much about the vertical band. Does anyone out there have any info. about this procedure? Isn't this the stomach stapling thing? I thought that was done away with. Why would my insurance cover that and not the lap band, which seems safer? I am so upset, all I can see right now is red! Just when I had decided that the RNY was not for me, now I find out that it may be all that I can have done since I am not financially able to pay for lap band surgery on my own. I just feel like crying.

I just wanted everyone to know that I was approved by my insurance company I got the call minutes ago:banana !!! I am so happy! My insurance company is Group Resources!! Yea!!!!!!!!!:banana :banana Oh yeah surgery date is still the same the 29th!! Whoo HOO!!!

Hey Everyone I am on the countdown now! I am on my way to the hospital to get my preop labwork done and to be preadmitted. I have worked in the lab at this hospital for 14 years. I know alot of people in that place. I know we have HIPPA protection but still people I work with will know. I have kept it just to my coworkers in the lab but now a few more will know. To me that means pressure cause they are gonna watch me like a HAWK. It is only fair because some of the people that had RNY that works at the hospital I kinda watched them like a hawk too. I mean the transformation is kinda hypnotic. LOL . I cannot believe that Monday is just 4 days away! Whoo HOo (I think, heheh…

I was told Highmark BCBS has been covering gastric banding for the last month. But yet once again TODAY I have been denied.They will cover Gastric Banding now But not Lapband what is gasticbanding if not Lapband.They say it is not FDA approved.My doctor said yes it is.I have Plenty of co morbitities. I have had six months of doctor supervised nutrion counseling and a mental evaluation for GAStic Bypass. I dont want GAStric Bypass. Thank's for letting me VENT.:angry Ladysplenda

Anyone in CA had success getting Highmark/ Blue Cross Blue Shield to cover their LapBand procedure? I've been denied saying it was experimental. I understand others have been approved in other states so I need to know if anyone in CA has been approved/had surgery. This info will help me in my fight! I need all the help I can get . . . THANK YOU!

I went to the seminar last night and got really excited until they told me that Aetna will not cover my surgery. What sucks is I changed my insurance a year ago. My company offers another insurance that will cover it. But I am unable to change my insurance until next july. So I guess it is a waiting game now. By the way I have Aetna EPO OPEN ACCESS.

Just heard today that Baylor Weightloss in Dallas is now out of network for UHC. So, now what? Do I find a new Dr. in network? What happens now? Does anyone know?

I have to call my insurance company to see if they are going to reimburse me for my adjustments, they paid for surgery but are not sure about the fills. I have to pay the surgeon in advance and then submit it to the insurance myself. Does anyone have the code for the adjustment with fluro? ~Mandy

I know that Texas Medicaid will pay for the regular surgery (sorry im not sure what its called lol) but wondering if anyone knows if it will pay for lap band too?

I just got my letter today. I have Anthem BC/BS VA (ppo). My only requirements where being 100lbs overwieght, BMI over 40, and employer rider. I had all 3 and i was approved on the first try. I call tommorrow to get my surgery date.

I am trying to get our insurance to cover my surgery however it is an exclusion on our policy. I am trying to appeal it and was wondering if anybody had any advice. I have wrote one appeal letter and got a NO but I am not willing to give up that easy!!! Someone said something about writing a letter to the company that my husband works for since we are self insured instead of going through the insuarance underwriters does anybody have any advice??? I take any help that I can get on this!!!!!

I just need to share some news on South Dakota insurance company. We have Dakotacare for our insurance. Both my husband and I were banded in Dec. We had already met our deductable for our insurance. Anyway we had to put up $570 up fron to our surgeon as the insurance company estimated they would pay all but $1140 -so we would pay half the rest set up in payments. Well to make a long story short the hospital put their billing in first so the $1140 was what was left for our out of pocket and then when the surgeon billed his services the insurance company paid for the whole thing. And we get the $570 back from them to apply to the hos. Our docs office was also very good abo…

hello everyone......i have private health insurance but my surgeon has told me i need to pay about $3000 out of my own pocket. Did u all have to pay this out of pocket expense too? Im just a bit confused as to why i have to pay this.I dont know if its the surgeon charging more or if this is what everyone has to pay. Thanks Fee

I had my initial consult on April 25th where I decided that I want to have the lapband - I went through the dictation process and the paperwork was faxed to UHC on April 29th. I called the insurance company on May 9th to see where the request was in the process and they said they had not received anything. I called my doctor and the information was re-faxed so I waited another couple of weeks and called back on May 31 - same thing again - the insurance company claims they have not received anything. Again the doctor's office re-faxes the information to the phone number supplied to me by Care Coordination at UHC - and the fax was confirmed... The insurance coordinator a…

As an active duty spouse having delt with Tricare and military hospitals for 7 years now I know that getting anything done that is not absolutly life and death through tricare insurance is like jumping through hoops of fire, backward, while twirling batons in both hands. If anyone has any information about being banded through Tricare I would be soooooo appreciative!

My medical insurance is through Aetna. They will pay for half the cost of the surgery if I meet all of their requirements. When I call they point me to their policy bulletin on line and tell me to discuss it with my doctor for clarification. When my doctor reads the policy she says that it could mean different things. For example, one of the policy items is an ‘Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional.’ OK, I have been attending Curves for a year and a half, but I wouldn’t call the people working there a qualified professional. My doctor says that Curves is won…

hey all, just wanted to let u all kno i finally got a date. im scheduled for surgery november 8 which seems like forever away but it fell on a good time bc i have alot of state holidays so i wont have to use all my sick time. the last hurdle is my insurance. pray for me guys, its been smooth sailing so far i just need this one last thing to follow through. thank u guys

My insurance company said that they would pay 90% of the surgery after the deductible, but I am not sure if that means they will pay for the return visits for the fills or not. I had to have a procedure code for the surgery just for them to tell me if they covered it or not, so is there a certain code that I have to have to see if insurance will cover them? Thanks!

Anyone have experience with these guys? obesitylaw.com

hey all, im in the process of trying to get my insurance (bc/bs nj plus) to cover my lap band surgery. anyone with any info or any helpful tips please share. im so nervous and waiting in in suspense to find out if im approved. please help. thank u

Has anyone used UT BC/BS for the lap procedure. I live in houston, TX and I am considering this and I read in my insurance guide they would consider surgery for people they consider "MORBIDLY OBESE" but maybe its for the gastric bypass surgery? I have yet to investigate. Just wanted to know if anyone has had the experience yet with this type of insurance. Thanks edna

Good morning all! I was banded April 7th but had problems with my "flippin port"...it flipped over and they could not access it for fills. So they went in on May 25 and put me back under and re-attached it "with fishin line. Now it ain't gonna move!" per my doctor. I was a self pay for my surgery and had to pay an additonal $250 to go back into surgery to fix my port. They told me that even if United Healthcare would not pay for the initial surgery, they probably would pay for the fills and the port repair. Well, last night I got my EOB from the May 25th surgery and they paid on it! Granted it was out of network and there was a $2000 deductible, but they still paid $203…

hey all, im nicole from brick nj. i am currently in the process of trying to get my insurance (bc/bs nj plus) to cover the lap band. im soooo nervous. my surgeon is in hackensack and altho the trip there sucks its worth if i can get this done. any help advice or would be much appreciated. anyone can email me direct at nik65652002@yahoo.com or IM me on AIM or AOL nik6569.

I have blue cross blue shield blue options. They do cover WLS surgery if medically necessary, but they have an exclusion for adjustable gastric banding. They cover the RNY and other surgeries. Is there any way I can fight an exclusion? Also, I was looking up the codes on their website and they do have a code for adjustable gastric banding. Which makes no sense to me if they have it excluded from coverage. Can anyone help me with this?

I've been fighting with the Insurance company (First Health) since March. They originally sent a list of criteria that I met. Then they came back and now say I have to go on the diet I will be on after the surgery for three months. According to my doctor, it looks like several insurance companies are going that way....so be prepared. I've met the first list of criteria, so after I do this diet for three months, I hope to be approved and on my way to losing. Carolyn

I can't believe I am writing these words. After a year of fighting for the band I just found out I am approved. I had given up on the band and was in the process of going for the bypass. A little back ground I have Aetna. It is a self funded insurance plan.I had to hire a lawyer I went through all of my appeals. Practically begged my Husband job to overturn the decision but they did not want to set a precidence ( their words) and finally had a 3rd party review who overturned the denial. I have a tentitive surgery date of August 29th. Since i did all of my tests a year ago they have to find out if i have to re-do any. Ireally hope not. So keep fighting for what …

What should i do? I cant get my insurance to cover the lapband per written exclusion and my credit is too damaged to get approved for financing. Are there any other options. I young so i don't own home to take out equity in. I dont have retirement to put up against it. Is it really over for me????????????? Can anyone suggest anything , please.