Hi All,

This is my first post, and I'm interested if my insurance would ever cover the lap-band procedure. I'm in S. California and have Blue Cross Blue Shield HMO through my work (I know yuk).

I'm a 5'7 , 41 yr old female and weigh 280lbs. I currently take 2 types of high-blood pressure medicine (for the last 4yrs and RX for extreme heartburn). I know my BMI is over 40. I'm also noticing more muscle aching and issues with energy, etc. (the usual over-weight issues).. I have to take control of this issue as it's just ruining my day to day life and I want to be around to watch my 10yr old grow up.

I have a long record of weight loss procedures I've followed be it Weight Watchers, Zenical, Atkins, Suzanne Sommers, etc. All have been somewhat successful, losing up to 30-40lbs, but always end up gaining back plus extra.

As I'm now 41, I just want off this merry-go-round once and for all, and after reading about the differenct options, I feel Lap-Band seems the least invasive and reasonable option for me.

What I really need is guidance on what I need to do first. All help is greatly appreciated!!!!

If I must end up paying for this procedure out of my own pocket, I am prepared to do so, but would like to try for insurance coverage if at all possible. Also, would I have better luck if I switch my coverage to PPO?

Again, thanks for all comments.

I'm in Texas and I have Aetna. Anyone have experience with either of these? I've never done much with my insurance company aside from basic GP visits and buying medications.

I had 6 challenging months with a Humana HMO, but finally was approved after my search started. :whoo: This is a good thing, because w/o insurance it would have cost me $16,700 for the 2 surgeon team & hospital I chose. There was a requirement, though, for patients paying via insurance to pay a program fee that was a small chunk out of pocket, but it was well worth it due to the expertise of our surgical team and the care we received both pre/post op at this incredible hospital.

My mom and I both had surgery done a month and a half apart at the same place. We first spent months of doing our "homework", then went to their seminar in January, and then had surgery - Mom in early May and me at the end of June. Mom had an easy time of it because she has Cigna and their approval was automatic as long as she had the documentation.

The seminar was invaluable in letting us know what type of paperwork to begin collecting, although I already knew most insurance companies required 6 months up to a year's worth of monthly doctor monitored care w/ possibly appetite suppressants. I already had almost a year's worth of care under my belt when we went to the seminar, so that was covered. I even had a year's worth of gym membership by that time also.

The surgeons informed me that I would have a real fight :boxing: with my insurance company due to it being an HMO (and I'm under a school district contract/policy, so...) and that they had NEVER had a Humana patient before that got approval. :omg: I informed them that I planned on being the first, due to all the documentation I had collected. Preliminary calls to Humana told me I "could" get approval if I had all the steps followed and paperwork. I can only hope what I went through in gaining approval helps future Humana HMO patients that come to them. It wasn't that Humana people were rude (a little condescending, yes) but every time I called, I got a different set of instructions from a different person. Very aggravating sorting through the bureacracy!

My PCP was terrific in writing a letter supporting my medical need for the surgery and copied all my files/labwork going 4 years back along with a bunch of other needed papers....needless to say the fax to Humana was 53 pages long!!! Humana told me to expect 2-4 weeks for their review board to look over my "case" and then I would hear back. Within 3-4 days after that massive fax, I got approval. :clap2: It was time to celebrate!!!! :whoo:

I've heard it said that if you don't get approval from your insurance company and it goes into appeals, forget it - you'll never get approval. I say to those of you in that situation, what have you got to lose? Keep trying! My case goes to show you that even what looked dismal at first turned out to be the cloud with the silver lining!

Banded 6/27/07 - VG band, Dr. Jose Erbella and Dr. Gary Bunch, Manatee Memorial Hospital, Bradenton, FL

:cat:

Hey, Pam, congratulations! And you are so right about people appealing even if they think there's no hope. There is nothing to lose and even if one person loses, the next one might win because of the fight. I was the first person to get Aetna to pay, so I know exactly how you feel. You go, girl!! :high5:

I hear that Blue Cross blue sheild covers the lapband and gastric by pass.. As long as your BMI is 35 or 40 and over.. 40 and over you dont need comorbestitys...

Rose

Hello everyone,

Currently I have Optimum Choice, Inc. and unfortunately the company I work for has a total exclusion for weight loss surgery of any kind, even if it's medically necessary. I am almost 39, 5'4", 250 lbs and have been on every diet possible with success for short periods of time and then total weight gain plus. I have several co-morbidities: high blood pressure, asthma, severe heartburn, depression, anxiety, major back problems, and possible sleep apnea. I am able to change health insurance companies in November to take effect in January. Has anyone had success getting all the prelimary work done with one insurance company (sleep study, nutritionist monitored diet, psych workup, etc) and have them transfer to a new insurance company? I'm thinking about getting all of this started now so that when my insurance changes, it won't have to take as much time to be approved.

Thanks in advance!

I am new to this also, i first found a qualified surgeon and they contacted my insurance which is hmo, i need to be on a guided and supervised diet for 6 month with my regular medical doctor before the insurance will cover the lap band procedure, in which i don't mind, but i have been on a diet with Beverly Diet Center for the past 7 months but I guess that does not count. Very frustrated..

I have heard of insurances accepting documentation that your PCP reviews and approves (i.e. Weight Watchers). You might contact your PCP and ask them if they will add the information to your records regarding your diet program and then submit it to your insurance company.

Has anyone had lap band approved by health plus of michigan.:thumbup:

Go to their general find a physician site BlueCard Doctor & Hospital Finder

Put in the first three letters of your card #. If you have the winning combination on the next page you will see;

"Blue Distinction Centers" on left side 2/3 up the page and bariatric centers are there. This way you at least know if they cover it and how close are you.

Also check with customer service at your insurance company. It may be hidden under a general medical policy. Mine was hidden under " medical policy #379" but it spelled out EXACTLY what proof is needed to be approved.