Ins. won't cover surgery, will cover other things?

[Kelly Ann 0]

Hi All

I have been lurking for a little while, and have been so inspired and excited for my upcoming banding. I'm just now in the process of selling my old 1957 Chevy, to help cover the cost of the procedure. I just changed jobs and was already given my policy (Blue Cross PPO) of what it will and will not cover. My coverage doesn't start until August 6th, so I don't think I just call if I'm not a member yet?? It says it will not cover weight reduction surgery's, even if it is Medically Neccessary! UUGG!!

So, my question is, for all of the testing that needs to be done before hand, will the insurance cover those? Or will they deny it because of what the testing is for?

Someone on here must have gone through the same thing...so I'm hoping to get some answers before August, so I can start saving more money, if I need to

Thank you all for sharing your stories and experiences with the band, I'm so happy that I found this forum! It really helps to know what to expect!

I'll be banded by Dr. Billy in Ventura, CA. I've already attended his seminar. He is such a nice guy and I feel super comfortable with him

Continued success to you all,

Kelly

[Qvrfullmidwife 0]

"So, my question is, for all of the testing that needs to be done before hand, will the insurance cover those? Or will they deny it because of what the testing is for?"

What I was told by the surgeons office is that even if you are cashpay they will bill the insurance company for what they can and in this case it woudl cover labwork, just billing it as needed for general health/checkups etc esp if ordered by your PCP.

[jojo64 0]

I know this is old news about insurance not covering the surgery. Well I have UHC Choice Plus and like everyone else here I was denied the coverage because of the 5 year diet history. The only thing that really gets me mad is that not only did I go thru all the tests and even checked with UHC before I started all of this and I was covered nothing was mentioned about 5 years as long as there was diet history. They also mentioned about the co morbid conditions. Now I have most if not all of them starting with type II, sleep apnea, High blood pressure, High Chl, Arthritis in both knees and even had surgery on one of them. Going thru all of this I am also suffering from depression. I am at this time appealing the claim at this time. I have letters from my PCP, Therapist, and even Psychiatrist. I don't think I am going to get approved anyway but I did not want to just sit back and take what they say.

[Chris61 0]

Why do you think that you would not be covered with the medical conditions and history that you have? I also have UHC and I had five years of stuff and was approved. THere was a couple of years I only had one date. I can forward you a copy of the letter that I used to get approved. I also went to all my old doctors and tried to get the weights/dates etc. and some did not have it. SO I just put that in my letter and had no problems. Good Luck any questions just ask

Chris

[jojo64 0]

They already stated that they will not cover the surgery because I do not have 5 years. I can only account from 2005. I am appealing it but I still think they are going to give me a hard time.

[Chris61 0]

Have you gone to all your doctors and gotton all the weights and dates. This would be OBGYN, and others as well. Also do you have any medical records at home at would have stuff like that on it. I had found some files that were medical related because of work and I also used those as well. I just made sure that it was in my medical file in case they requested it. I hope that this will also help you out.

Chris

[jojo64 0]

The doctor I had growing up I have not been to in over 15 years. I tried calling her and she said that my records were destroyed because of inactivity. I never went to any other doctor since then. I wrote a letter in the appeal process trying to convience them of using some other form for the record. I will find out in probably about a week or so.

[adagray 1]

Going back to your original question, I would be upfront w/your doctor and let them know that even though the lapband surgery may not be covered, you like them to try to get the other things covered if there is a way to link it to a different diagnosis code that would go through. A lot of doctors do this automatically, but it doesn't hurt to be upfront about it. For example, when I had been TTC for 6 months w/no success, I told my OBGYN that I wanted to move forward w/testing for infertility. Although my insurance would not cover testing until I had been TTC for 1 year, she was able to find other 'reasons' for the tests so that they would be paid for by my insurance. In the end, all the testing was paid for by insurance and even doses of clomid she was able to code as for something other than pregnancy. Don't ask me how! LOL The only thing she couldn't code otherwise was my DH's SA so we paid out of pocket for that. No biggie. I got PG within a month after that. :->

[adagray 1]

By the way, I am going to talk to my doctor about doing two surgeries together to see if that will help (in case I get denied for lapband surgery). I want to get a tubal anyway (and that is completely covered by my insurance) so I am gonna see if its possible to do both surgeries at the same time so that I only have to pay out of pocket the fee for the lapband surgery itself (which I think is maybe only $5-$7k if the anasthesia, operating facility, etc. are already being paid for another surgery). In any case, whenever I get the lapband surgery, I want to get a tubal ligation at the same time. So, its not that I'm getting another surgery I don't want. I would just like to time them together and if it helps w/paying for lapband, that would be awesome. But, trying to do it this way is only my Plan B if my insurance won't cover the lapband. If I can get both surgeries approved and paid for then that is what would really be best. Anyway, I'm just mentioning this because a lot of ladies would like a tubal (after they are done having children), but figure it is not worth having surgery over so they have their DH get a vasectomy instead. But, if you could get it done at the same time as lapband and not have to go through a second recovery, then I think its a great option. Anyway, I am just in the very very beginning stages of seeing how I can work this through insurance. I am meeting my doctor on 1/6 and hoping she can give me some advice on this. I will update on here after I talk to her about it.

In my case, I am worried my lapband won't be approved because my weight history goes up and down. Personally, I feel that is more evidence that this surgery could really help me and I'm going to try to write a strong letter about that when I submit to insurance. But, we shall see what they will actually approve.

[HarleyGirl 1]

My insurance wouldn't pay for the surgery, but did cover most of the pre-op testing. I had to pay the psych consult out of pocket, but everything else was covered under a general physical.

[jojo64 0]

that is the funny thing about all of this. UHC approved all of the tests that I went thru for the surgery. So once they were paying they already knew that the final outcome was going to be and that was the surgery. I still got denied.. This is the first time that I am haveing any issues with them anything they just paid with no questions. The worst part of all of this is that I started this process the begining of May. I am starting to lose faith about getting approved that is for sure