Hi. I am new here. I am considering trying to get the Lap-Band done to help me lose weight. I just called my insurance (Aetna) and the lady said it was not covered. Did your insurance cover the procedure? Did they give you are hard time about getting it covered? If you did not have insurance how did you go about paying for the procedure? Thanks so much.

Miranda:cry

Hi. I am new here. I am considering trying to get the Lap-Band done to help me lose weight. I just called my insurance (Aetna) and the lady said it was not covered. Did your insurance cover the procedure? Did they give you are hard time about getting it covered? If you did not have insurance how did you go about paying for the procedure? Thanks so much.

Miranda:cry

My insurance did cover it...HOWEVER, the first lady I talked to at the insurance company just blathered out "it's not covered". I told her "Oh yes it is!" Because I had just emailed my DH's HR benefits department and they told me it was covered if I met the criteria. SO, the rep put me on hold, came back, apologized and sent me the criteria in writing.

I was NOT covered by my DH insureance... I paid 12,000. Deanna

My husband insurance said they didn't cover under no certain terms. but I started a new job which the insurance did cover it, but I kept my husband as secondary. And we are finding out they are picking up what my insurance doesn't pay.

My husbands' insurance covered it. It was First Choice through the Teamsters.

I have United Health Care through my company and according to the benfits management groups it is covered. Iam waiting for them to send the requirements. My wife and I both have an app. to do the prelimary stuff for the doctor in a couple of weeks and then meet with the Dr. the following and hope to have approval by end of August. If you have any questions you can e-mail me at VCW61@excite.com

Thanks

Chris

Pre-Band

St. Louis

My insurance Federal BCBS covered it and I will owe $100.

I made a half-hearted effort to put in the papers realizing it was going to be an uphill battle. Decided to go ahead and self-pay knowing I could regulate my surgery date myself. I am much happier that I did it that way. I would not want to have waited months or years for some yo-yo at an insurance company to decide how I live the rest of my life. pppfpffffttttt to that!

My insurer was Aetna at the time, and when I first applied 2002 they excluded the band across the board. Neither Aetna nor my employer excluded bariatric surgery, mind you, Aetna just carved out the Lap-Band itself. They said it was "experimental."

I fought that through two appeals and an external review, and finally won. Aetna had to cover my band, and sometime after that they revised their coverage policies and no longer exclude banding from their covered bariatric treatments. BUT: every state is different, and large groups can often configure their own contracts, so it's not safe to say that Aetna covers the band in all situations. In my state (NJ), in small group plans, for qualified individuals, Aetna covers banding in the same way it covers other bariatric surgeries.

Now that the band is six years out of FDA approval and is covered by Medicare, most carriers treat it the same way. If coverage is not available it's NOT because there's anything special about the band versus other kinds of bariatric surgery. It's more likely that bariatric treatment is excluded entirely due to state allowances or employer decisions. If you're medically qualified and are seeing any other reasons for denial, APPEAL. It's crucial that we all know our rights and take appropriate, aggressive steps to get the care we need.

I am in the process of meeting my insurance requirements. I have United Health Care and they do cover the procedure. I just have to do all the leg work before submitting my paperwork to them. I would not go with the first thing someone tells you @ the insurance company. It's worth a try if you have the time & patience. However if you have the on hand to pay for the surgery out of pocket I probably would to avoid the insurance hassle.

I too have Aetna, and they are covering my surgery, but believe me I had to dance through hoops for six months to get it done. Sleep studies, nutritionists that tried to talk me out of it, 6 months on a diet with my general practitioner, which I've done a million times and cried when I found out I had to do again, cardiac tests, rhuematologists, etc., etc. It's been a nightmare, but I'm almost done. Just have some group sessions to attend and a psych evaluation, then I'm ready!!

My insurance covers it if you meet their criteria. I have Health New England. I was led to believe it was 6 months with supervised diet and a bunch of other stuff, ie: psych, dietician, exercise,. But this morning I was told it is a year of supervised diet. How discouraging!

I have Humana and it will cover lap band surgery after a six month, medically supervised and documented attempt at weight loss. I'm hoping for a surgery date in December.

I couldn't even get health insurance because I was so overweight. I was a selfpay. Put down a deposit and made monthly payments.

My insurance covers it if you meet their criteria. I have Health New England. I was led to believe it was 6 months with supervised diet and a bunch of other stuff, ie: psych, dietician, exercise,. But this morning I was told it is a year of supervised diet. How discouraging!

I had to do a twelve month MD supervised program as well. I was also told initially that it was a six month requirement, but the insurance company changed their criteria on me. Oh well, I used the time to learn as much about this and what to expect as possible. I also started eating the "bandster way" with small bites, choosing good foods, not drinking with meals, etc.

My advice to anyone who has to do the supervised diet, do not miss one single monthy visit, not one! My insurance company has a compliance requirement and if you aren't attending (meaning going to the MD) monthly, then you start from square one.

Well, interestingly, my plan excluded it from coverage so I decided to go the self-pay route. It was going to be about $16,000 for the surgery and pre-op stuff. However, the hospital still submits all bills and I'm shocked at what they covered. They didn't cover the anesthesia or the band but did cover the surgeon (go figure. Apparently it's okay to have surgery but no anesthesia for me!). They covered the lab work and pre-op visits (except one visit to the nutritionist - $120). Still waiting on whether they cover the hospital room or not but so far they've paid about $6000. Not bad!