I just want to give everyone heads up regarding insurance coverage. I spoke to my carrier BC/BS of New Mexico. They do cover lap band for patients with a BMI 35-40 who have co-morbidities, without a huge list of other hoops. That was the good thing I have been very excited because knew I was qualified and just had to wait it out.and go through the steps. I called again today and asked some more questions. What I found out is that even though those are the requirements for the insurance company , my employer has tacked on another more strict condition and you have to have a BMI of 40. No exceptions for co morbidities, or the fact that the plan covers it. I am so upset right now. ( crying of course ) So I either an sol or I would have to gain a minimum of 25 lbs to qualify. So I am basically out the $450 program fee I paid, and the $250 copay for the endoscopy. I was too upset when I spoke to the surgeons office to ask for a partial refund of the program fee. ( they will probobly remind me that it was non-refundable) Anyway just a heads up for those who are borderline, to not take the insurance companies or surgeons word without asking a ton of probing questions, and restating the information back to them, to make sure it is correct.

Thanks for the reply and heads up. When you got your policy was it during open enrollment?

I am going to school full time for Medical Billing and Coding. This semester we started on our Insurance part of the class. From what I understand (and also clarified with my instructor) during open enrollment an insurance company is not "supposed to" use the pre-existing condition against someone. If you did start your insurance during open enrollment, make sure you fight them tooth and nail.

"Regulations about pre-existing condition exclusions may vary from state to state, but generally speaking the following applies: If you are enrolling in a health plan on an approriate eligibility date (such as open enrollment, taking a new job, becoming newly eligible due to marriage, etc.) pre-existing condition exclusions do not apply"

My wife just signed up during open enrollment...so going by what I have read and researched, pre-exisiting condition should not be a problem. Keeping my fingers crossed.

Not during open enrollment but as a new hire...I will heave to look into that rule.Im in Texas so I wonder if that applys here..Thanks for the info....

Preexisting comobidieties will actually help you get the band faster in this case.

I sure hope so.....