Maggie225

Blue Bug I would consider calling your insurance carrier to make sure the figure from the surgeon's office is correct (it sounds a little fishy to me) and if it is correct I would find another physician if I were you. Don't give up hope:rolleyes:

This is just my guess, but I would say that you should contact your BCBS and see if they have that 6 month grace period like bjornsyouruncle stated. Or if you have your insurance packet you could maybe read through there and see if they have a grace period???? Just my 2 cents, I hope you can get them to pay for it so you dont have to wait a whole year, that would really suck:thumbdown: Good Luck, keep us posted:cool:

The actual lap band surgery IS covered but the extra services which they call "bariatric resources" is not covered. I asked the UHC rep if this really mattered and she said probably all the things I would need could be done through the surgeon, as Jodi stated above. All the bariatric resource people do is find you a surgeon and cover other stuff with you, so it's no big deal that my husbands employer doesn't carry this extra service. I'm not sure if the extra service helps or hinders your approval, but I'm just glad to know that the procedure is covered and I had 2 different UHC reps plus the bariatric resource nurse that I talked to confirm that the lap band was covered under procedure code 43770 (in case anyone wants to know the code:cool2:) through my insurance. Now I guess I need to take the next step, I do have a BMI of 35.1 and I am diabetic, I have PCOS and I have knee and back pain so hopefully that will be enough to get it approved. *keeping my fingers crossed* I'll keep you all updated as to how it goes

I called my insurance today (United Healthcare) and Lap Band is covered at 90% which is awesome but then I was told I have no Bariatric Resource coverage, which I guess is just a service some employers pay extra for, it covers having a team find you a doctor and I guess they work with you and help you understand the procedure, aftercare, etc. I'm guessing this is no big deal because I have already found a surgeon close to me (1 1/2 hrs drive away) and I'm sure he will give me the info on the surgery, etc right? And this surgeon is in my network so there shouldn't be any problems. The question I do have is; when I asked what the guidelines were for the lap band all the lady could give me was the "generic" version off something she was reading, she stated you must be obese and have health problems relating to the obesity, she did not give me any BMI numbers or anything???? When I visit my PCP and he sends me to the surgeon will they be able to get all the guidelines? I really wanted something in writing to take to my Dr. so he could see the guidelines. Well I guess I'll just go and if I get denied I'll appeal it.:laugh:

I was so happy to find this thread. I also have UHC choice plus and I was a little concerned about whether or not I would be approved. My BMI is 35.1 and I have PCOS, I had gestational diabetes with both my pregnancy's and my paternal grandmother and father both had diabetes. (both died in their early 60's) I also have documentation for the past 6 years for weight loss consults through my PCP's office (he has had me on every prescription drug out there and none of them worked) but I dont think my BMI was over 35 everytime I went. My sugar level is very close right now to putting me in the diabetic catagory and I'm really hoping that I can get my insurance to approve the lap band. Dose anyone know if I have enough "stuff" to get this approved?

Thank you Mely, it makes me feel much better knowing someone close to my size was aproved. I have UHC and I'm hoping they wont give me a hard time....lol

I think only you can answer which way you want to go with this, but if it was me I would go with the band. If something happens later in life the band can be removed, if your not losing weight in can be replaced with a smaller band. I just think the lap band is a much safer route to go, just my 2 cents :thumbdown: I have a friend that had the bypass done and she was one of the unlucky one's that had a horrifying experience, I'm sure you've heard a few of them, but anyways she is fine now and the only thing she has to on a regular basis is get b12 shots monthly. Good luck to you I'm sure you will make the decision that is right for you:wink:

Welcome, I'm new on here also. I have not had the lap band yet but am hopefull that I will be able to in the near future. Best of luck to you :thumbdown:

Welcome, I am also new to this site. I wish you all the best :thumbdown:

Yes thats what I am afraid of...Denial..... but I do have documentation for the last 6 years from my Dr. for visits all relating to weight management, he has put me on every known prescription weight loss drug out there and none of them worked very long. Do you think that would help with my insurance?

Hello my name is Maggie and I am addicted to food....:thumbdown: I am new on this site and have not yet made the "appointment" to see my physician. I am 5'7" and weigh 224#, my BMI is over 35 and I have PCOD which makes me a high risk for diabetes (which also runs in my family) I guess I am just afraid that my Dr. or insurance company will deny me so I'm fearfull of going. (Stupid right?) I should just woman up and go.