I was wondering before you ever figure out if the insurance will pay, what do you have to pay for out of pocket? And what is it paying for? I know there are some kind of tests you have to go through and do they cost and can anyone give me the low down on any of this. Thanks for any input.

Hi there,

If your insurance will be covering the surgery, or even if not, it's definitely worthwhile to have them cover the initial appointments and testing. The only problem with this would be if your carrier absolutely excludes any and all costs related to the treatment of morbid obesity. That's the first thing you have to find out.

If they do not--and MANY carriers have an exclusion for "obesity treatment, UNLESS in the presence of a diagnosis of Morbid Obesity--then all your appointments should be covered in accordance with your plan details. Your physical, evaluation testing, initial consult with the surgeon, etc., etc. are all by way of being treatment for a covered condition.

When the time comes for your surgeon to submit a request for precertification, that's when you'll find out whether your carrier covers banding, and whether they agree it's medically necessary for you. I faced three denials from my carrier (they excluded the band altogether at the time), but since they covered RNY they paid for all my pre-op testing and evaluation. It's all the same thing--treatment and evaluation for treatment of a covered condition: Morbid Obesity. Get that diagnosis in your file.

Also, be aware that if you DON'T go through the insurance carrier for this stage of the process, it's less likely that they will agree to pay for the surgery when the time comes. Most carriers require some evidence that you have been seeking medical treatment for this condition, and it's a lot easier to show that if your providers have been filing claims all along.