can some one help us please

[justcallmequeen 0]

Hi-

I am 25 years old from North Louisiana (Shreveport-Bossier area) I am having lap-band surgery in 2006 but our insurance doesn't cover the surgery. Blue Cross Blue sheild of Lousiana is our current insurance, but weight reduction is excluded. I have PCOS (polycystic ovarian syndrome) angina, lower back pain, high blood pressure and asthma. Because of PCOS my husband and I are unable to have children. Lap-band is our only hope. If there is anyone who can give is just a little bit of information please send us a reply or drop us an e-mail: queenbuttafly@yahoo.com

I pray that there is someone who can give us some information to help us. Thanks.

"With God nothing is impossible"

[princess_n_thep 2]

Call the bank and get a personal loan????? Sell a vehicle? Borrow from family? Have garage sales and sell extra stuff? Get a second job from home? Lots of ideas, just depends on how bad you want it.

[DevilMayKare 1]

It's not clear from your message exactly what kind of information you want. Were you inquiring about the band in general or financial questions...? I suggest you go thru the "general informaion" and "support" sections and just start reading threads. Then do a search for topics you have questions on. If you find a particular person informative you can do a search and see every post they ever wrote.

There is more information here than you could imagaine! We've all had the same concerns so I think you'll find almost every question you have has been asked and answered at LEAST once. (I can't even hazard a quess as to how many times "What's a PB?" has been answered.) So read, read, read away and come back and ask us something more specific and we will be glad to help.

[justcallmequeen 0]

Sorry you guys-

I wasn't being more detailed in what we were looking for. We were looking for an insurance company that will cover the whole lap-band surgery from start to finish. We have blue cross blue sheild but weight reduction was excluded. I need the lap band surgery for medical reasons, but our insurance company will not pay for the surgery even though its for medical reasons. I did do an appeal to blue cross blue sheild but they will "NOT" cover the lap band surgery because they say that it is too dangerous. So my specific question was, Does anyone know of an insurance company that will pay for the lap-band surgery without writing an appeal. Its been so hard and frustrating I want to scream. Every Insurance company that we try does "Not" cover lap-band its excluded. Am I taking the wrong approach? What do I do? Im clueless

[princess_n_thep 2]

There is always the self pay and finance option?

I think ethics are in question here if you are just looking for an insurance company just to have them pay for the band. The band costs them a lot of money. And I am guessing that you would only be with them for a short time to cover the band? That isn't very fair to the insurance company and them paying out the nose for the band is what is making things that much more difficult for others who have been established with their insurance companies for a long time, and they are struggling.

My advice? Finance it and self pay. Think of it like a car payment!

[Guest G8trChick]

I have United Health Care through my employer. They approved me on the first try. I'm getting banded 10/28/05. Since my plan is through an employer, you may want to talk to your Human Resources or Benefits Specialist as it is my understanding that the employer decides what is excluded in a group plan. Hope this helps.

[Alexandra 55]

So my specific question was, Does anyone know of an insurance company that will pay for the lap-band surgery without writing an appeal. Its been so hard and frustrating I want to scream. Every Insurance company that we try does "Not" cover lap-band its excluded. Am I taking the wrong approach? What do I do? Im clueless

Shopping for an insurance company has to start from the ground up. Your options are dictated by your location, so your first stop is a local broker who knows the market in Louisiana. Whether you can buy an individual policy or not, and all the rules related to that, are state-mandated and nothing we say here will be of any help to you if you are not eligible.

Call a broker! That's what they're there for. And there's no charge to you. You may not get the answers you want but at least you'll have the correct information.

[justcallmequeen 0]

Thanks to everybody and all the support. I am going to try United Health care and see what they offer if they offer here in Louisiana. I am so excited, but at the same time I am scared to death. I hope that United Healthcare is offered here in Louisiana. I looked at United Healthcare on the internet, but just kinda looked over and to the person who said I was just looking for an health insurance company for a short period of time thats so untrue. I am looking for health insurance for good. Thats so mean. I was truly offend by that comment. I am looking for long term health insurance for myself and my husband. For those who can't find health insurance its just a question that I didn't know and wanted a little help. Every body needs a little bit of help sometimes!!! Did you hear what you said "it seems like you will be there for a short period ot time". You know nothing about me to just make that assumption. Right now can't afford the "finance option" we have only been married one month and he is the only one working and I am a full time student so we don't have that option. So please if you have something helpful thats great but please don't insult me! I am very offended! I would never ever say such thing.

[the best me 6]

I did do an appeal to blue cross blue sheild but they will "NOT" cover the lap band surgery because they say that it is too dangerous.

So, they denied the appeal because it's too dangerous? Not because it's not a covered benefit of your plan? You might can appeal that?

In other words, if your insurance doesn't cover WLS for any reason, no matter what, well, you are sunk and are in a psooition to seek a policy with that coverage. In that case, go shopping. Be prepared to pay well for your premiums, too. Do the math, you may be better off financing a self-pay than paying high premiums for coverage that requires some type of pre-existing condition waiting period...ah, so much to consider!

However, if your insurance policy does cover WLS and they denied your claim because they don't like to pay for that particular procedure because it's too dangerous...well, there are lawyers that will help you to appeal it. Many people win but look for a nice sized bill for that.

Good luck!

Also, there are plenty of ladies here with PCOS who are struggling with the same issues as you. Do a "Search" (on the blue bar above) and type in PCOS and the threads will come up.

[Alexandra 55]

Justcallmequeen, don't be offended. I think the point princess was trying to make is that no insurance carrier is going to smile on anyone seeking coverage for a specific condition or procedure. Laws are in place depending on where you live that protect insurance carriers from consumers shopping for coverage in that way.

Kathy makes a great point, though. You really should try appealing if the only reason you were given for the denial is that the procedure is "dangerous." That's an absolute crock, and they know it. I won against my carrier on appeal and it was a similar type of denial.

Who do you have your insurance through? Is it an employer plan? Individual? Maybe your husband has a plan you can explore buying into?

[princess_n_thep 2]

I am sorry you felt so offended.

[ReneBean 3]

I have been denied by Blue Cross, also - and they are a pain in the petute to get any information from... but, call and hold for the 15 minutes and get specific information. IF you don't know exactly why they denied you, then you cannot make a satisfactory appeal. Read the sticky thread in the insurance section and read the Blue Cross thread. If your denial letter reads similar to mine, it could mean anything.

**I really beleive that the insurance companies are going to deny everyone the first time - because if you don't care enough to make an appeal, then you probably dont have what it takes to be a successful bandster... So, make the appeal. You have a case and you don't need a lawyer or anything. You and your surgeon can make it together. Make use of your surgeon - and make use of Inamed. Read those other threads and fight.

[Danistar 0]

The other thing I would try is go to a Lap Band surgeon and ask them their advice. If you have serious health problems, they can help you to figure out what to put in a letter for your PCP to write to send it to the insurance company.

[rjdow 0]

Appeal Appeal Appeal don't let them win!! That is what they want you to give up. I am in the same boat I am on my second appeal now and have my third waiting for the denial so I can shoot it off on the same day! I also have PCOS and diabetes hypertension blah blah blah the list goes on!!! It is an exclusion on my husbands insurance as well but it won't be by the time I am done if I have anything to do with it. This is no different in my eyes then alcohol and drug addiction and they pay for those so why won't they pay for the treatment of food addiction???

[liannatx 897]

My insurance wouldnt pay for it at all. I ended up getting a loan at the bank. You will hear of many folks who end up self-pay. I think my health and quality of life are worth it. Good luck.