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

insurance question for someone in the know



Recommended Posts

I have Health Alliance which is based out of Champaign. That is also where Carl Clinic is where DR Roscheib (spelling) from Clinton does a lot of surgeries. He's recently been doing the band. As yet, my insurance doesn't cover the band and I wonder if it ever will. I wonder if the insurance company is working with Carl to determine the success of the band. I know it's cheaper, if it works as well, why isn't the insurance companies jumping on it?

Share this post


Link to post
Share on other sites

I know it's cheaper, if it works as well, why isn't the insurance companies jumping on it?

It takes a lot of evidence to convince insurers that something new is preferable over something established. Even though this surgery is cheaper, the case can be made that it's not as "reliable" in terms of helping MO patients take the weight off.

Also a factor, I'm certain, is the industry's fear that a lot MORE people would go for bariatric surgery if banding were more widely available. The seriousness of RNY probably keeps many, many medically qualified candidates away. It sure kept me away! So carriers would have to be shelling out untold amounts of money to treat people who currently cost them nothing.

As for the future costs of allowing patients to remain morbidly obese, we'd think carriers would care about that, right? But they don't. Any given individual is statistically likely to be someone else's problem in the longer term.

All of this will come home to roost as the population ages and grows fatter. I personally believe that banding will in time become the WLS of choice, and people will have to prove immediate need to qualify for RNY. But this will be slow in coming, like all medical revolutions within the insurance industry.

Share this post


Link to post
Share on other sites

Thanks Alex...that's what I've been thinking. I'm a little surprised nobody else commented. I'm sure that I'm not the only one checking out this site that isn't banded. I don't think I'm alone in "waiting to see what insurance" does either.

Share this post


Link to post
Share on other sites

Great question , if you ask me the pharmaceutical companies NEED us to be taking blood pressure meds , cholesteral meds , Water pills from the bp meds , etc , etc , etc ,they could very possibly be working together , I know I sound paranoid but at this point I can sure be certain that it's not my well being that the insurance company is concerned with !

Lisa Jarva-pre-op

waiting impatiently to be banded , having second thoughts , having a sleep study with cpap this Sat , diagnosed with apnea. I've been told I'll have to go through a "medically managed weight loss program" before surgery will be approved due to the Mental health portion of the insurance requiring it for the tests before surgery....grrrrrrrrrrrrrrrrrrrrrrrrrrrr

Any thought or info on this is always greatly appreciated.

Share this post


Link to post
Share on other sites

I understand the Dr supervised diets...been on one for years. I'm 390+ lb, 5' 7" and 40 years old. I was a week away from the bypass and backed out because I could never see long-term results...it's much simpler to die from obesity than to be operated on and stress your body with malnutrition...maybe a bad attitude about it, but I've heard of lots of problems. The band was what I wanted even back then. I have borderline diabetes, high blood pressure, and severe sleep apnea. My goal isn't that lofty...I'd like to be below 275. I see a lot of people with the band that do very well and some that it looks like wasted their money. If you don't change your lifestyle and what you eat, it won't work. However, if you do change your lifestyle and what you eat, you should lose weight. That makes me hesitate from doing it. I don't think a band will work for someone who eats ding-dongs. May not be able to eat as many ding-dongs, but they still won't get good results. Right now, I'm doing the excersise thing. I do the eliptical for 20+ minutes a day (2500 steps because my short fat legs move no faster), lift 3 days a week, and try to do the bike 4 miles 5 times a week. I've stepped it up quite a bit from just lifting..I wasn't losing anything. Dr told me more cardio so I bought the bike. In the last week, I started the eliptical...I'm planning on sweating it off. Did 35 minutes yesterday morning and went to bed at 7:30 last night! I'm trying to eat better...more meats and fruits. However, I eat like a horse. I think the band would help me with that a lot. I think if my insurance would cover it, they'd say that my BMI was too high.

Share this post


Link to post
Share on other sites

Medicare just approved the lapband in January. Usually other private ins. companies follow with in a year or so.. Medicare sets the bar, the others try to stay with them.. ( thats not saying some ins. cover things that medicare doesn't but they usually follow their lead)

Hang in the, I was in the same boat with Bcbs. our employer had it wrote out of the policy but withmuch fuss from many employees we now have it as a option. I am just starting the process I have my first visit next week.

Share this post


Link to post
Share on other sites

Good for you. However, I think with a bmi of close to 60, I'll be in a fight with my company for coverage. I think they're putting too much emphasis on the BMI and not the individual...Oh well, cross that Water when I get there.

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

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 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

    ×