Well - I've just spent the last little bit reading through my entire insurance benefit book. I read every page - word for word...literally.

I came up with 3 different things - and they were all in 3 different sections. Here they are in the correct order in which they were found, and what section they were found in....

-------------------------

Hospital - Inpatient

Medical Conditions

"Confinements for the purpose of weight reduction (including gastric by-pass, stapling, ect.), unless Morbidly Obese."

-------------------------

Laboratory / Pathalogical Testing

"Tests associated with weight reduction or smoking cessation programs"

-------------------------

Surgeries

"Surgery for the purpose of weight reduction (Examples: Gastric by-pass, stapling, ect...)"

-------------------------

It states that NONE of the above are covered I'm kinda bummed.

The first one throws me off though - where it says, "Unless Morbidly Obese"

Now - since my insurance states that none of these listed are covered, does this mean that the surgery is NOT possible at all? Can I try it - and appeal? This is all new to me, so I'm sure I will be confused with it all.

Has anyone been able to get the surgery when the insurance first says that it is not covered?

Thanks for any replies!

~ Kari ~

Kari, your best bet is going to be calling your insurance company direct. They should be able to answer your ?? There are other bandsters here that have used Dr. Deol. Try the "Search" for her name. We'll be waiting to hear what you find out. I'm crossing my fingers, eyes, and toes for you -- that it will be good news!

From the little I've read--and Alexandra is the expert here, not me--it looks like your insurance DOES pay for bypass surgeries, for the morbidly obese, probably with documentation that you have jumped through certain hoops. The next item is to see if they even mention LapBand or "adjustable gastric band," anywhere in their literature.

They may say that they consider it experimental. (Which is stupid, but some companies till get away with that approach.) They may say that they pay for it only with certain physical conditions being present. Or they may just pay for it!

Find out what the starting point is and don't geive up too soon and don't assume they'll pay for it and then get depressed if they don't. It's a step-by-step process.

Thanks for the replies New Hope & GeezerSue

Yes - I will still call my insurance company today and see what they say. I was just getting antsy (sp?) over the weekend and thought I'd read their book lol.

I definatly know not to get my hopes up. This is something that I believe I want done - and I know it will take time. I'm sure there will be instances where they will deny me. I'll get through it.

I'm even thinking of other options if I am denied several times, like self pay, ect...

Thanks so much again for your knowlege, and support!

~ Kari ~

Is there a way that you can find out whether your state has passed this legislation that requires insurance companies to provide benefits for this procedure?

Kari, your state's Department of Insurance can tell you if there are state mandates about coverage. It might also be under the Department of Health, but either way the information should be readily accessible. I know in New Jersey, there are lots of mandates about coverage for small groups, but almost all bets are off when it comes to large-group coverage.

To find out what the situation is in your state, visit your state's website.

Kari - Make that call today, you will feel better afterwards. Keep us posted.

Betty

Hello everyone - well I made the call to my insurance company. I asked if they cover Adjustable Gastric Banding.

The lady kinda hesitated - and then told me that she would have to call me back shortly. So I am awaiting their phone call.

In the mean time - I did make an appointment to go to a seminar with Dr. Zoe Deol. That will be on October 19th.

So I suppose I'll sit here, work, and wait for their phone call!

Thanks again!

~ Kari ~