Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Trying To Get Approved For Lapband Surgery



Recommended Posts

Did anybody have any issues with getting approved the first time?

Share this post


Link to post
Share on other sites

Many do. So many variables can disqualify your application. But, if your plan does provide coverage of WLS you should qualify unless your BMI is under 35 with no co-morbids.

tmf

Share this post


Link to post
Share on other sites

My BMI is no where under 35....I didn't know if it made a difference or not cause I don't have any pre-existing conditions like high BP, diabetes, etc....

Share this post


Link to post
Share on other sites

Every insurance company is different. Some make you go on 3,6 or 12 month diets. My insurance allowed me the surgery based on my bmi

Share this post


Link to post
Share on other sites

It varies from company to company. I would recommend you get a copy of your insurance policy and see if bariatic surgery is covered and if it is find out the guidelines for getting it approved. If it covered I would work with my primary doctor to get a referral to a bariatic surgeron. That's the steps I took to get my approval.

Share this post


Link to post
Share on other sites

My BMI is no where under 35....I didn't know if it made a difference or not cause I don't have any pre-existing conditions like high BP' date=' diabetes, etc....[/quote']

Mine was 34 & I got approved with a powerful appeal letter.

Share this post


Link to post
Share on other sites

I had to do tons of pre op tests like sleep studies, upper GI and even my gallbladder out. After that my insurgence said they wanted 6 month supervised diet. THEN after that my insurance denied me. My BMI was a 52 and then still denied. Luckily I have a great bariatric center and they appealed it and FINALLY I got approved as medically necessary and 3 days later got banded.

It's different for everybody but definitely look into what your insurance covers . Good luck

Share this post


Link to post
Share on other sites

My procedure was approved in 7 days. I have Tricare Prime. GOOD LUCK.

Share this post


Link to post
Share on other sites

Kaiser Permanente--sleep study, psych eval, morbidly obese (BMI in 40s), two comorbidities (pre-diabetic, sleep apnea), PCP referral--took about four months for approval and had to pay 50% of the cost of surgery myself. Good luck!

Share this post


Link to post
Share on other sites

My procedure was approved in 7 days. I have Tricare Prime. GOOD LUCK.

This makes me so happy to hear! I have Tricare Standard and was hoping that I could get approved before my husband deploys!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×