New to the forum and find it very helpful! I've been thinking about getting the Lapband for the past three months. I finally went to a seminar to see what are the first steps needed to start the process. I called my insurance company (United Healthcare) and found out that they do cover the surgery with the normal guidelines. At the seminar I found out my BMI was 54, I have no co-morbidity and that with my age I was a very good candidate for the surgery. The question I have is.....that most of the weight lost surgery programs here in Ohio want you to pay a program fee. Some starting at $300...$500...even up to $800 non-refundable fee, and has to be paid before they will even submit to your insurance for pre-authorization. I'm not too sure in just giving up this money and not knowing for sure if my insurance will approve it. What should I do?

the more I learn the more it hurts...

:faint: :angry

The program fee that one doctor was charging was $5,500 for a five year plan. After I inquired what it was for - office visits, fills, nutrionist and labs regardless of your insurance status. When I told them that my insurance covers this , they could not explain it. Needless to say, I found another doctor that does not charge any maintenace fee and the same follow ups are done (fills etc.)

I say shop around, but of course don't comprise on your health.

Program fees are the doctors way around insurance - insurance doesn't pay that much - they want to be a provider for blue cross - they bill bc $1000 they get $150 - so i my opinion it's just a doc's way to make more $$$ - I paid a LARGE program fee - it covers me for 5 yrs - I have no co pays to my doc, have personal attention, see the nurtritionst every time i go - I think my doc give me very good attention for that program fee - I have his cell # if I ever had a problem - - I am lucky enough to have had it and it was for my health - better than buying a diamond ring. what use is a diamond ring when you are dead due to your obesity....

My doc charges a $300 program fee, it includes a huge book they have put together, vitamins, protein powder for shakes, exercise bands, unlimited visits to the nutrionist and exercise guru, unlimited access to the gym at the hospital, monthly support meetings, a pedometer, and I'm sure I'm missing something. They won't let you pay this until you have gotten all approvals from insurance as well as all clearances from the other doctors.

I paid $495 as a program fee. It was due at my first consult with the surgical group here in Virginia Beach. The fee covered the nutrition classes, all post op md appoitnment co-pays, the exercise class. After the consult if the group felt you were not a candidate they returend your fee immediately before you left the office. I think the fee serves two purposes; it shows committment on the part of you the patient and it covers all of the incidentals that the insurance does not cover.

As far as "it is due to how the insurance companies search for ways to end up denying us". I have found that the reason for most denial is due to bariatic surgery not being a purchased benefit or that an MDO has not completed all of the necessary/required information needed to facilitate a favorable decision.

I'll be asking about that one, thanks!

Remember that any out of pocket medical expenses can be included in the medical deduction at taxtime. Food/shakes and gym memberships aren't but those fees, YES.

Susan

PS

The total of your oop med expenses do have to be 7.5% or 8.5% of your AGI.

United Healthcare is a PPO, it is illegal for your doctor to charge you a dime other than your co-pay prior to billing your insurance first. You are smart to question this practice.

$3500 in S Cal had to be paid up front before surgery to surgery group

I am overwhelmed by the vast range of differences for every person who gets this surgery done. As if the nightmare of waiting to hear back from the insurance company is not stressful enough, then you have to pay program fees on top of it all. I hope it is worth all this. I am waiting for my insurance company to make a decision. My surgery is scheduled for 2/18.

I'm in South Florida and my doctor charges a program fee of $600 that's due 7 days before the surgery. They charge this fee only after you've been approved and have a tentative surgery date. It includes a bariatric manual, online learning modules, mandatory fitness classes at the hospital gym, Pre-Operative and Post-Operative Education Classes. A bunch of other classes and support group privileges.

I should also note I have United Healthcare PPO and they offer similar programs for free online and on the phone. I'm just happy to get the surgery approved and don't mind paying the extra $1100 out of pocket for the program costs, nutritionist visits etc...

I live in TN and I had to pay 150 non refundable and it's for a web site that you have to goto and fill out your history and it's for life i believe. Plus I had to pay for nutritionist apt which was only 39$. Not to shabby.