Insurance & Financing

I have the EPO plan under UHC and was wondering if anyone else out there has been banded having this option. The only bad thing about this option is that your Dr's have to be in network or they are not covered. I am currently in the process of trying to get UHC approval but am wondering if they do approve the surgery, should I assume that will include the anesthesiologist, radioloigist, and whatever else? I know my surgeon is in network but I'm not sure if anyone else is. Just wondering if anyone else has had the Lap Band done with the EPO option..... AL

Hi everyone! I have been through all the processes necessary for surgery for my daughter. She is 14, 5'3" and 268 lbs. She has always been overweight and moved into the obese catagory at 3 years old despite a "normal" eating pattern. Well, Monday I verified that the insurance company, BC/BS of MN, had received the papers from the Doctor that included two psych eval's (just in case since she is bi-polar). I was informed that the case was in the medical review boards hands. Question....how long do I wait or how often do I call the insurance company to find out about approval/denial? I am anxious and hoping for the best (knowing deep inside we will probably get d…

I had my psyc eval today. It was exhausting, but I'm glad I did it. Anyway, the psychologist said my tests indicate that have a high tendency towards problematic compliance. Which basically means that consciously I have every intention of following the after-care regimen, but my sub-conscious kind of takes over and knocks me off the wagon. An additional component of this is that I let the "world" think I'm doing ok. She said that wasn't a problem as long as I would agree to see a therapist for the first six months to help me through the rough spots and as another source of support. Of course I agreed to do so...whatever it takes to be successful at this! She is g…

Anybody, know if United Health Care covers, the band?

I am only 2 weeks post-op. I was wondering about the cost of fills. Is it usual for the Dr. to include a certain number of fills with the surgery cost? If so (or if not), how much do the fills run, and does anyone know if UHC covers them? Thanks.

I contacted both of my insurance companies; and both my insurance companys told me WLS are not covered under my plan. 1). Primary = Anthem BCBS Blue Preferred Primary Plus (POS) As of 2004 they have an exclusion: Related to weight loss or treatment of obesity. 2). Secondary = United Health Care Choice They do not cover weight loss surgeries. I can't believe it! Now I have to come up with a plan B. I am so sad.

Has anyone had unicare pay for lap band surgery. I really want to lose weight and can not do it on my own but I can't afford to pay for the entire surgery either.

Hello everyone: I know Medica will cover the surgery,but, I'd like to cut down the hours I work and go under hubby's insurance Aetna (which will not cover the lapband). So, my question is. Are fills included in the surgery bill? Will another insurance pick up the cost of fills even though they wouldn't pick up the surgery? Thank you all. I read all your posts, and will soon be on the other side in 2 weeks. Gabby

Hello everyone, My bestfriend is in the process of getting approved. She was denied by LINECO (BC/BS of IL POS) for only having a BMI of 40.6. She was also told that she has to have 6 months of medically supervised weight loss attempts (yet they will not pay for a nutritionist). When she stated that the FDA approval is 35 with significant co-morbidities and 40 is indicated without, the claims person told her that because the group is self-funded she needs to have a BMI of 45. Along with her 40.6 BMI she has high blood pressure and PCOS/Insulin Resistance. Does anyone have any advice I can pass along?

Hey Alexandra, Because of your work, I think you have one of the best perspectives on insurance issues of anyone. Long story short -- I'm still trying to get my claim paid from surgery last August. (The surgeon's office obtained verbal approval from a high level Cigna exec. and failed to get it in writing, as did I. If it was good enough for the people who were going to get paid, it was okay by me. Lesson learned!) Cigna PPO denied my initial claim and first appeal. I was ready to hire Walter Lindstrom (Obesity Law Center) to handle my second appeal. Then my surgeon's office called today after contacting the state insurance commisioner's office...and was told our pl…

Hi Everyone, I have my 1st app. for a consultation with the DR. in Jan. and I am learning so much from all of you. This is my ???........are the costs of the fills included in the surgery or is it something that has to be approved each time or how are you billed for that ?? Thanks, Ihvbzs from NJ

i have anthem blue cross in va will it cover lap band it says it covers obesity surgery or is hard to have insurance cover it

Does anyone know if M-Care health insurance (in Michigan) covers the surgery?

HAS ANY BEEN APPROVED FOR SURGERY THAT HAS THE EMPIRE BLUE CROSS BLUE SHIELD INSURANCE. MY INSURANCE WILL CHANGE AS OF THE FIRST OF THE YEAR. I UNDERSTAND THEY ARE DIFFICULT TO DEAL WITH. NEED TO KNOW IF ANYONE HAS GOTTEN APPROVAL AND WHAT THEY ARE LOOKING FOR. THANKS, JOANNE

If you have Encore please email me at charbabe1967@aol.com and let me know how long they took and what all you had to do to get approved! Hugs! Charlene

While you are waiting for your approval do not be afraid to call your insurance 2-3 times a week. Don't be a pest but keep on them. I found out on 9/22 that I was denied because I called them. I wouldn't not have found out until 10/2 if I would have just waited for the letter. So since I already knew a second letter has been submitted and they have now requested additional information. Out of the 4 things that they have requested 2 of them are done and the other 2 will be done Monday night, 10/6. It is so worth calling them. (I also keep a call log) Just thought I would share.

Did anyone get approved for the surgery with this insurance? I am trying to research this for a friend in Delaware. Thanks

I just found out that my employer will be using United Healthcare again next year. I am moving forward with my plans on being banded but I am just getting started. ANYONE who has dealt with UHC and has any advise to pass along I would really appreciate it. Thanks!! AL

Has anybody gotten approved for lap-band through MESSA insurance?

Has anyone been able to get approval from your insurance after being told that they consider the lapband "investigational"?

I have a family member who is intrested in getting the band done. His BMI is a 55. Does anyone know if CIGNA (pos) covers the lapband?:

I've heard that several insurance companies require evidence of 6 months or so on a medically supervised diet. Other than it meaning that one must go to the doctor, what exactly does that mean? For example, is 4 visits to my family pracitioner over 6 months sufficient? What about 2? I went to my doctor in August and discussed my weight and he presribed me wellbutrin to try for weightloss (I never fill the prescription after reading the side effects). Would that mean I'm "on the clock" towards six months? Thanks! Bob

In Tennessee, one of the major insurance companies that cover the lap band surgery is John Deere. I was curious to see who has John Deere insurance and if so, how long does one usually have to wait before they are considered to be covered? I don't have insurance right now, so I have to back into this, being careful not to create any "pre-existing" attempts for weight loss surgeryon my files. THis is veryfrustrating, but if everything is done correctly, they will pay for the surgery %100! Please give me feedback if you have any!

BCBS at least in michigan is requiring as of Nov. 1, 2003 that you show a consecutive medically supervised weight loss effort for at least three years. I was told in order to qualify, my surgery has to take place before Nov. 1. My consult and psych eval are scheduled for Oct. 8th. Is there any chance that I would have approval in time for surgery and be able to have the surgery by then? I was not in a hurry thinking I would wait until in December when I have more vacation time I could take.

Hi Everyone, I am a Federal Government employee interested in having the lap band surgery and would like to hear from anyone in the Washington DC area who has had it. Would also like to know if their insurance company covered it and the name of their doctor. Had previously considered the gastric-bypass surgery but ruled it out because of the severity of the operation. Thanks and look forward to hearing from you.

Wow, this is NEWS for Aetna folks. Aetna has changed its Coverage Policy Document on bariatric surgery. It doesn't actually embrace lapbanding, but it DOES open the door for people who have significant contraindications for RNY. There are some contraindications listed, but as we all know they can't possibly predict all the cases. For example, if I were going to try to appeal my denial again now, I'd make a strong case that the rapid weight loss following RNY surgery was in itself something I could not accept. That sort of rapid weight loss significantly disrupted my life 13 years ago, when I lost 75 lbs in 12 weeks on Optifast. For the full picture, visit Aetna's websi…

Hello to all! I have finally made a decision to try to schedule an appt. w/ my primary physcian to start the process for Lap Band surgery. Unfortunately, I have medi-cal insurance and have been warned that they may not approved this kind of WLS. Can anyone tell me if they have gotten approved w/ medi-cal? Thanks for any advice/suggestions.

I've read that many insurance companies don't want to give coverage to post-op gastric bypass patients. Has anyone here experienced any trouble like that since being banded?

Called my insurance and was told they do not pay for such surgery...interesting that they will pay for me to be ressected! as is done with the other type of bypass surgery.... anyone else been told the lap is not insured, then to appeal and have success? I have not submitted, just called... Any others paid out of pocket? Thanks, Amy

Was anyone able to get Lap-Band surgery approval when their company had an exclusion policy? I have Cigna Insurance, and I am from St. Louis, Missouri.

can anyone give me any advice on how to get Health Net to pay for lap band...i have an HMO so i know i need to start with my primary care Dr(i do know her from working in the hospital so i should have no problem in a referral from her)...any advice pls

Well I was denied because they said I didn't have 26 weeks of a medically supervised diet. I gave in copies of my doctor's patient progress notes, you know, the pages they write on every time you see the doc. I didn't have a cover letter. They said they couldn't go through all those pages and they wanted the information all on one page. I called my doc and they were getting a letter together to send with the progress notes again. BTW, these progress notes were from the past TWO years, a bit more then they need. It's in the appeals department now and hopefully will be OK soon. I start on the liquid diet Monday.

Anybody have any experience with BCBS PPO in Florida? If so, how does one even begin?

I have Mail Handlers and I've been fighting with them since Jan. or Feb. I can't remember now it's been so long. I have my final appeal in with OPM. My Mail Handlers plan is federal so OPM is kind of like the State Insurance Boards for state insurance. Hopefully they will over turn Mail Handlers decision. If not I will just get a loan and self pay in Mexcio.

hi all...i just found out that i might be able to change my insur from Kaiser to Health Net(and i know they approve lad band) anyone have any advice on how to start the insur process w/Health Net? Do i need to go through my primary care 1st?

Hi everyone,i just started the processes... I have done the research,and now know i want the lap band..I went to my primary who didn't know much about it but did say we sould rule out any problems with my heart first. That came back good. I dont know what to do next? I live near orlando, florida and to my knowledge theres no doctors around here. Is there something the insurence will want to verify before I request coverage. Any help would be great I am definatlly at a point were if i dont do something soon.....well lets just say i feel out of control. Thanks erika oh ya, I have united health now and we are up to change insurence If anyone knows of a insurence that covers…

Has anyone had any luck with Anthem Federal (BCBS)? I am getting conflicting info from them so I just wondered if anyone else knows anything. I called them with the codes the surgeon gave me and they said they were to vague and they needed more info before they could tell me if they covered it or not. I decided to go ahead with the psych eval and then let the surgeons staff deal with the insurance!

My sister who lives in Pennsylvania went to an information session for the LapBand, she is changing jobs and her new employer has Keystone Central. Has anyone out there had this insurance and been approved?

I Getting ready to fight AvMed. I haven't started yet and I would appreciate some advice and feedback about other peoples battles. Thank you

Required documentation of medical need.....faxed over by surgeons office....received approval 1 week later. Almost too easy!

It's happened! I just got a call from a lovely woman in the Aetna External Review department to tell me that they and my surgeon have come to an agreement!!! Oh my god. I feel like screaming! I can't believe it. I think I'm hyperventilating... :D

Has anyone had any experence with AvMed? Thank you

Anyone have the same insurance? Email me! My hubby's first consult is 8-12-03. So far we have had to pay for the nutritionist eval and psych eval out of pocket. Bummer. I will update all insurance information as we get it.

My Drs office faxed over a letter of medical necessity. They received the LOMN on Wednesday afternoon and I recieved a call on Thursday morning approving me. It could not have been easier. United Healthcare made the whole process easier and my total cost for my LapBand surgery was ZERO! Lisa

Has anyone had any experience with getting approval from BCBS HMO BLUE in Massachusetts? I saw something on another site that said it took 2 appeals, but I am not able to contact that person(no email address.) I am hoping to get approval without any trouble. Kaci

I am looking for someone who lives in the Tricare Region 6 area and have had the Lap-Band. Please email me with any suggestions, comments, information, tidbits...... Thanks-Dawn (really pre-band)

i recieved approval in three weeks! not to bad. i did call alot and stay on them. the only requirements for the surgery was the weight... 100 lbs. i'll post how much i have to pay out of pocket once i have been banded;) michelle

Does anyone have GEHA or heard of it? Does it pay for the Lap Band?

Does anyone have Ins with Alliant ? My husbands Ins. is changing in Sep. and I was needing to know wether they pay for it or not with my husbands Ins. now it only pays 4,444.97 and that stinks! So I am hoping and praying this Ins. company will be better than that!

I have BCBS Traditional Insurance in Michigan. I also am salaried at General Motors, and am required to get a preapproval on all surgeries. They covered the operation minus any copays, and deductibles. The total cost of the surgery was about $15,500. I paid about $1,700 out of pocket. I only encountered two minimal, but annoying problems. First of all the psych eval had to be co-signed by a PhD, or a Medical Doctor. BCBS would not accept the psychologists' signature because she ONLY had a Masters degree. Secondly the communication between the insurance carrier and the doctors office was poor. They played phone tag with each other for two weeks. I finally took ma…