amy4hr

Where/How do I find the CPT code? Thanks!

I completely agree that logically the lap band would be far less risky due the procedure being dramatically less invasive. I would still like to hear more about long term weight loss and possible side effects/complications from the band.

I was just thinking of posting something similar! I keep going back and forth wondering if this is really what I want to do. Now that gastric bypass has been around for years we are starting hear some disturbing information about the long term effects and wondering what those long term (5, 10, 15+ years) might be.

Liz, I haven't been denied but I haven't started the approval process either. I haven't met with a surgeon yet, I am just trying to understand what my benefits are and how much I would actually end up spending out of pocket before I decide if I want to move forward. I thought maybe if someone had a similar plan as mine they might be able to give me a real answer as my insurance company isn't answering the question. I recently read the average "insurance cost" is around $30000. If my out of pocket maximum is $2500, and the insurance states it will cover 50% up to a lifetime maximum of $15000, who is paying for the $12500 difference? Am I expected to come up with that difference? If I am expected to pay that much, I am thinking I might as well do self pay and them file the claim myself and be reimbursed. Does that make sense? Have you already been approved? Did you complete 6 months of MD supervised diet? Thanks!

Almost seems like the smart thing to do would be to self-pay and then submit the claim myself and save the money. I find it interesting that there is all this talk in the news/insurance industry about being a smart health care consumer, yet the insurance companies/doctors seem to make it very difficult for us to do that.

I didn't think to ask that, but should have! I was more concerned about understanding how the coverage actually works!

My insurance will cover the procedure at 50% with a maxium coverage amount of $15000. I am curious if anyone has had a similar type of coverage and what your out of pocket actually turned out to be. My out of pocket maximum for the plan year is $2500, but curious to know what happens when the $15000 maximum coverage for WLS is filled. Also, I am curious to know what the difference has been in costs with those with insurance and those without and why. Thank you in advance! Amy <!-- / message -->

My insurance will cover the procedure at 50% with a maxium coverage amount of $15000. I am curious if anyone has had a similar type of coverage and what your out of pocket actually turned out to be. My out of pocket maximum for the plan year is $2500, but curious to know what happens when the $15000 maximum coverage for WLS is filled. Also, I am curious to know what the difference has been in costs with those with insurance and those without and why. Thank you in advance! Amy

Dreamer, Would you mind sharing what you paid w/ Dr. Ortiz? I have heard many great things about Dr. Ortiz, but not in my insurance network. My insurance will cover 50% w/ a dr in network. There is a Dr. in Lubbock in network but I have heard very mixed things about him and would rather use a dr I know cares about their patients.

I am new to the group and considering lb. As I have been researching my options and surgeons I am finding it very difficult to find reputable and highly recommend dr's nearby. I currently reside in western TX (in the panhandle). I would greatly appreciate any advise/recommendations. Thank you in advance! :help:

I am new to the group and considering lb. As I have been researching my options and surgeons I am finding it very difficult to find reputable and highly recommend dr's nearby. I currently reside in western TX (in the panhandle). I would greatly appreciate any advise/recommendations. Thank you in advance! :help: