Insurance & Financing

It is friday morning 3/18 at 10am and i am FREAKING OUT!!!!! I am scheduled for lap band surgery April 7th. I am 38 yrs old, with a BMI of 49. I have sleep apnea. My insurance co is BCBS for State of Ct employees. My insurance policy allows the surgery if "medically necessary". I also have letters of recommendation from my PCP and Gyno doctors. My surgeon's office handles everything and says they have had good luck with my ins and it will be fine. I am stressing because they have not approved it yet!!! They have had the ppwk for 3 weeks and three days ago asked for a copy of my psych _eval. I have a part time job that I need to give notice to and I am going to Italy for …

Theda clark medical center called me today wi Badger care/ forward card Doe's not cover adjustable lap band surgery.will do all other's. So im going to move to minnesota where it's covered < ha ha > Minnesota covers it!

Wondering if anyone has Blue Care Network in Michigan? Or when you may have been denied & than fought & won. What did you do -what did you send in- who called the surgeon or your PCP(regular dr )? How long did it take?

Hey everyone.....I'm hoping the lapband procedure is in my near future !! My question is, is there anyone that has had the procedure approved from Tricare or Triwest. Maybe any even any military dependants out there. My consultation is March 30th with the Naval Hosp. in San Diego, CA. I know they are currently offering the bypass surgery, but I'm going to push for the lapband. I'm not sure if they will send me out or not. Hoping for a miracle. Thanks, Kelly

My insurance thru the workplace does not cover for my wife. Does anyone have any suggestions?

Hi all, I am wondering how changing health insurances works. The insurance that did my surgery was wonderful. Approved it the first time, (2days), and has paid for my 2 fills 100 percent. However now I am changing employment and my new insurance is Aenta. My questions are 1. If I have complications from my band (which was done in July 04 and I have not had any problems), will they cover any problems if any come up in the future 2. If Aenta does not cover the lap band will they cover the fills???????? I do plan on calling Aenta to ask, but can't do that until Monday. By the way its cold up here in Maine, and we are expecting 16-24 inches of Snow tonight and to…

As yet, my insurance Health Alliance doen't cover the Lap band. Are there insurance companies out there that didn't cover the band but are covering it now? I was just curious if Health Alliance is slow coming around or if all insurance companies are slow coming around? What's the popular concensus...are more and more insurance companies covering it or are they all holding out?

My job is going to give me an allowance to pay for medical insurance, but I am in the dark as to coverages. Is anyone educated on this subject? I need help in finding a good plan, please help.

I am just starting this process and I have Blue Cross of California which is where my company is and I work out of my home in Texas. I don't know what I am up against in getting approval, but one doctor's office I called said you had to document and have proof of lots of trying to lose weight, including a 12 month weigh-in with a physician in trying to lose weight. I haven't done that in years! And don't even remember the doctors I did it with in the past. If you can share with me what you documented for the insurance company I would appreciate it, as well as who did you surgery if you are from the Dallas/Ft. Worth area. Thanks! Deby

Has anyone been approved that has Blue Cross PPO of Tennessee? I'm set for my doctor on Feb.5 for my approval, I'm not worried about them approving me. It's the insurance company. I want this so bad!!! I have been overweight since I was 10.I'm tired of starving myself to lose weight.If anyone has could you tell me what all I need to do?

When I went to see my PCP last week, he gave me a prescription card that states "morbid obesity and joint pain". I've spoken to the Banding doc office and they stated that I need more than that - although since I don't get to see them until Friday, I don't really know what to request from the PCP. (they didn't give me a lot of detail about what should be in the letter - only that the prescription card isn't good enough...sigh) I'd like to draft something then drop it off at the PCP office, hoping he'll put it onto letterhead and sign it. Part of the problem, I think, is that he gave me a referral to the weight loss clinic within the health system - I can't even get a …

I havent hear anything from my Dr. or my Ins. I have been calling twice a week for the last three weeks trying to get answers.. but just kept getting the run around.. This morning I had my Husband call and kick some butt!!! He stayed on that phone with them until he heard something worth while of being on the phone at all. UHC has all the paper work.. ohhhh but it was in the wrong Dept. sitting there to rot i guess. Finally this morning it went to the right Dept. and they are putting a RUSH on it. They better rush it im in a RUSH to save my life and health!!!! I guess I just wanted to talk!!

we are in the chat room!

I'm just starting to look into a lap band. I have keiser permenete individual plan and resently found they only cover gastric bypass which I don't want. Does anyone know a so cal insurance that might cover lap band surgary?

i just wanted to thank each and every one of you because my mind has not been made up about the surgery .reading about the thing that are going on in your life make me feel that i am not alone and may god bless each and every one of you .cant wait anymore ready to go forward.

My doctor is in the process of sending a letter to United Health Care. I have enlarged heart and Type 2 Diabetes...plus being 50% over my body weight. Has anyone else had good luck with United Health Care and know any ins and outs. Thanks! (I am new to all of this.)

My mom was so excited because she found out Mailhanlers (sp) paid for LB, but when the doctors office applied they discovered Medicare was primary and not MH. Now it looks like she will have to pay. She's 73 and on a fixed income so I guess we'll see how much they will pay. She's diabetic and was so looking forward to getting off meds.

Has anyone had success with them approving the lapband? And if so how long did you wait to hear from them? Did you call them to push it along or was it smooth sailing?

Has anyone had United Healthcare PPO insurance where weight loss surgery is specifically excluded by the plan and then been approved? I don't know whether this exclusion in the policy is the absolute final answer or just to scare you off from trying. I don't want get my hopes up. Also, has anyone in Dallas Texas had the surgery done in Mexico and had trouble finding a doctor to do fills around town? I certainly don't want to travel to Mexico each time $$. Thanks for any info. I'm just starting out and have found this sight very helpful and inspiring.

Hello everyone! This is my first posting. I am right in the middle of gathering information about this whole process. I talked with my insurance carrier (Aetna) and bariatric surgery for weight loss is a covered benefit for my particular policy with no cap or limit on the procedure so long it is medically necessary. Please correct me if I'm wrong but from everything I've read a BMI of 40 or more qualifies you for the surgery and is what's considered medically necessary IF this type of surgery is a covered benefit on your policy. The Aetna representative told me this surgery (CPT code 43843) is like any other surgery on my policy - all I need is a referral from my PCP…

Right now i am waiting for my doctor to do a peer to peer with my insurance company. Has anyone else had to do this? did you get approved? I'm going crazy waiting to know how it went.... Any info would help... THANK YOU!!!

Hi everyone - I'm new to the board, and everyone sounds so wonderful, supportive and helpful. I hope someone here will have some information or can point me in the right direction. I've been researching the banding process, results, etc., but can't get any straight answers on insurance coverage, partial or full. I have Anthem - Blue Cross/Blue Shield in Northern Virginia. Help! Anyone out there??? Ndnroper in VA

My BCBS of Alabama policy lists the lapband as an exclusion to WLS. Has anyone been successful at appealing and getting coverage even though it is spelled out as not being covered? If it's going to literally be a waste of time, I'd rather go ahead and get the ball rolling by going to Mexico, going into debt and paying for it myself. But, if there is ANY chance I might get coverage, I want to try. Any advice?!!

Hey Folks, I got my approval letter in the mail yesterday :banana :banana :banana I cant believe it I'm on my way!!! Now all I have to do is calm down and wait for the doctors office to open so I can ask him what's next. You all have been so supportive and I tell you I needed that since I've been waiting since Oct. Thank you, thank you , thank you.

Does anyone know if they generally approve the Lap Band procedure? Does anyone have them as their primary insurance? Thanks in Advance

My first posting..... I am trying to get lap band... I have blue cross/blue shield health select. But where I work, it has a exclusion on this matter. My doctor has had me do a sleep test. I have high chol. but not diabetes. Is there is a easier way to get this approved. I did see a lap band doctor. He has referred me to the doctor who would be doing it. But that is far as it has went, they did call me yesterday, wanted me to fax them more paper work..... IF ANYONE can tell me what else to do I would greatly appreciate it..... Have a nice day and god bless you..

I just went to my intial visit, and was told that my insurance request would be sent in, so now I am just waiting to see what happens next. If anyone out has had the band done with Unisted Healthcare. Please give me some insight on how long it took you to get approved?

I'm wondering if your insurance pays for the banding proceedure, will they pay for the fills afterward? What is the typical charge for a fill?

Holy Smokes-- I had my initial consultation with the surgeon yesterday. Today--I have 4 different appointments/consultations scheduled. 1. Appointment with a cardiologist--I have an irregular heartbeat. I knew about it and it hasn't been an issue or concern with my PCP. 2. Appointment for a EGD--I've only had acid reflux 2 or 3 times, one time after a taco bell feeding frenzy when I was about 8 months pregnant. 3. Appointment for a abdominal ultrasound. 4. sleep Study-- According to a 9 question quiz, I may have sleep apnea--My husband has only complained about my snoring a few times. Snoring seems to happen when I'm sick. I do wake up about once a night--I have a …

Just had to share.... God is so good, I just heard from my surgeon that my insurance will be covering my second surgery for my revision! PRAISE THE LORD! I know I have pestered everyone to death asking for you to pray for me about this and I appreicate all your prayers and concerns. Please keep me in your prayer as I go through the surgery this Friday, 2/11/05 at 1 p.m. Just had to share.... God is so good! [/url] Brenda Fain

I have been banded since Feb 2004 with a 135.5 pound weight loss within 11 months' time praise the Lord. Anyway now my band has slipped and I am scheduled for revision surgery this Friday and have not heard back from BCBC of MA for approval on the revision. They are who covered the first surgery to get the lapband so I am praying they will cover the revision. Any of you had slippage and had to do revision? If so if you have this insurance did they cover for revision surgery? I am praying they will.... Thanks for any prayers from you all on this....

Has anyone had any luck with BCBS PPO in getting lap band approved? I'm in Illinois. Thanks!

http://www.thelapband.com/FlashHome.cfm?pagename=mm2 Hello all~ Here is a guide i'm using to gather INS. info together. I'm not in this region, but I'm finding it useful. If there are other check lists that are useful please let me know. I'm getting my diet history together to bring into the specialist. Are there any other suggestions of what to bring in and talk to a specialist about??? I'd just like to be as ready as I can be. thanks ~chena_cita

I'm getting closer.--Almost there I received a letter from Horizon BC/BS of New Jersey yesterday. They need a couple of additional items of information from my Doctor. First is psych evaluation and clearance--that is done. They also require "Enrollment in a multidisciplinary integrated program to provide guidance on diet, physical activity, and behavorial and social support prior to and after the surgery". The clinic that I have chosen for the surgery provides all of these programs--they even have a gym in their office!. I hate to be premature, but I think I'm getting close to bandland!

I am in the beginning stages of researching/comtemplating lap-band surgery. My insurance co. is CRL (Central Reserve Life). There is a loosely worded exclusion for obesity treatment in my policy, and I have e-mailed the ins. co. regarding coverage, and they e-mailed me back a NO. Anyone have this ins.? If so, anything you can tell me is greatly appreciated! Elizabeth D.

Hello, I've recently began looking into having the lap band procedure. I currently have aetna insurance. They basically said no to the procedure approximately 1 year ago. I'm somewhat afraid of going to Mexico to have the procedure. In as much, I'm wondering if anyone has had the procedure and successfully used an insurance company that was not associated with his/her employment. If yes, please help me. I'm desprate. My body hurts and I'm having some health issues associated with being obese. I'm even considering trying to pay for the procedure out of pocket. Thank you in advance to anyone who can assist or even takes the time to read this thread.

I have great-west health care. Iam still waiting on approval for lapband. Doctor office called says they need structer dieting for 12 of the last 24 months . Called great west if I can show any effort of dieting they may approve. Says weight watchers would show attempt. So iam going to get past records when I was on weight watchers. Great west also says surgery is 2-15-05, no one told me. Iam getting very nervous and excited all at once

My insurance wants a psychiatric evaluation. Has anyone been through this? If you have can you tell me about the evaluation. What they ask etc.... Thank you

Our insurance just changed to Schaller Anderson in October. Has anyone had any dealings with them?

Went to a support group meeting last night and one of the 2 local lapband drs showed up. Among other things, he informed us that Cigna is in the process of putting into place a NATIONWIDE policy that excludes lapband surgery. He also said that Aetna will mostly likely do the same. On a local level, Blue Cross/Blue Shield with the Texas Teacher Retirement System (TRS) will continue to pay for the surgery for now, however, all other BC/BS policies in Texas will exclude lapband surgery. He did not say when all of these changes will go into effect. Whats up with all these exclusions, all of a sudden???

I just checked with my Insurance Bluecross blue shield of Wisconsin I have a $2500.00/deductible then its 80/20 I need to know what the complete cost so that I am understanding what I will be paying. I am still checking I think we get a deductible reimbursment. If anyone can help let me know? The insurance person I spoke to me told me that I will not be covered in 2006 for any gastric surgery at all.. I need to get the ball rolling... 5'4 280 41/yrs

Okay--Here's one for you. I requested a copy of my emloyers medical policy. The response I received from my HR department was interesting. Apparently, we do not have a medical policy--(nothing in writing anyway) yet. Our company moved to BC/BS of NJ nearly one year ago. Any thoughts as to whether this work to my advantage (or not)? I don't have any severe co-morbidities (yet) other than high blood pressure and some knee-joint/arthritis issues. My BMI is 39-40 depending on whose height measurement you use. I guess I wouldn't be considered obese If I was 8 feet tall. Happy Holidays!

Hello Everyone - My name is Linda and I am in the process of trying to get lapbanding approved through my Cigna Open Access Plus policy. Under my policy it must be proved that it is a medical necessity, and unfortunately I have many of the co-morbidities on the list including diabetes, hypertention, severe sleep apnea, depression, and neurological complications due to my diabetes which has left me wheelchair bound. Currently, I am on my first appeal, but will follow through to the end if necessary. I am having all the same problems mentioned in so many of you about Cigna - but the most frustrating is that they say lapbanding is experimental. My surgeon has agreed t…

Hi All, Guess what, I got an email from my doctor this morning. He said that the insurance company is going to make a decision after Dec. 27 so I need all of you to keep your fingers crossed and say prayers. As all of you may remember I have been waiting now since mid October. I am hoping to get the ball rolling in January. Gee that would be a great birthday present as my birthday is Jan. 30. At any rate say a Christmas prayer for me that I will get approved.

I'm not a happy camper. I just returned home from a week long trip to St. Louis and in my stack of mail, I recieved a bill from Dr. Richard Benevides office. Interestingly, I saw this man one time in June when I had a slippage and was seeking help. Before seeing him, I spoke with his office and others and was assured that he took my insurance. I showed my insurance card at the desk and they took my co-pay. Never to be heard from again. Today, I get a bill for this consultation for $180. Merry frickin Christmas!

:think I got a rejection letter from the insurance today! Can I just say- They stink!!! I actually have some much stronger adjectives to describe them but I will spare all of you the cursing. Our reviev determined that the denied services(Lap band) requested are NOT MEDICALLY NECESSARY based on the following: There is no documentation of 12 continuous months of medically supervised weight loss program that includes nutritional therapy, behavior modification, supervised increase in activity, pharmacologic therapy-unless contraindicated-and maintenance support. This 12 month program must have been in the last 24 months. Programs such as weight watchers or Jenny C…

Hello All: Need all your good thoughts and wishes--My pre-determination letter has been sent to my insurance company (BC/BS of New Jersey) today. THINK APPROVAL THINK APPROVAL THINK APPROVAL!

Greetings all, If you read my last post title "Flipped out Angry :(", then maybe you can help me with the problems I may be facing trying to get approved for the Band surgery. I have read about people filing appeals and most eventually getting approved for the surgery, but I just don't know where to go from here. It's like what I found out about my insurance is written in steel and I really feel blocked and lost. Please help me get started on what I should do next. :cry Thanks so much! Judy

Hey just curious, are there any Pacificare of Calif people out there and if so how long to get approved and what obstacles did you run into? I have had the surgery and now filing to get them to reimburse. Thanks.

I began looking into getting a lap-band in June 2003. I originally had CIGNA insurance. I had no serious co-morbidities at the time but had a lengthy history of them in my family, including diabetes, heart disease, high cholesterol--everything. They denied me and said in part because the lap band wasn't proven to be successful. I didn't appeal. Then we switched insurance companies to Blue Cross/Blue Shield. After several months of trying on my own and losing nothing, plus being put on medication for high blood pressure and being diagnosed with borderline diabetes, I contacted my surgeon and got the ball rolling again. Fortunately I didn't have to do the psych or nutri…