Any change of being approved by ins.?

[peki31 37]

I have been wanting to have lap band for a long time. The group plan at my husband's office excluded it from the policy. We are getting our own policy on April 1 (Care First Blue Choice). Right now I have a 37.8 BMI and no health problems. Is there any chance that I will be approved by the insurance company? Or should I just go ahead and do a self pay? A friend told me it would take at least a year with a new policy to even get an answer. I would hate to wait that long and have no chance at all.

Also, if I do self pay and go out of state to get it done, would I just go to a doctor around me for fills and appointments? I have so many questions...lol. but, i'll stop for now. TIA!

Edited March 25, 2010 by peki31

[BetsyB 9]

Whether or not you will be approved by insurance will be spelled out pretty concretely in the policy itself. Without reading the contract, there's no way of knowing whether you'll be covered.

My policy (for what it's worth---which is nothing LOL) covers the procedure for BMI of 40 or over, or BMI of 35 with 2 comorbidities.

When you purchased your own policy, were you able to choose coverage that works for you in this regard?

Take a careful look at the policy when you get it--it will clearly spell out the requirements you must meet.

Good luck!

[emjay 8]

Hate to tell you, but if it is excluded there really isn't anything you can do. But as BetsyB said, it will be covered in the Summary Plan Description (insurance manual) that you receive as to whether it is a covered medical benefit or not.

From what I am gathering, many plans do require a 6-month medically supervised diet beforehand and the 35 BMI w/2 co-morbidities is pretty "standard" as well if you are between 35-40 BMI.

I have no doubt is you're self-pay you could get the procedure alot quicker. Myself it only took 3 weeks after my initial consult. However, it's a big chunk of change.

Also, please note that most plans, if they do not cover certain medical procedures, then they will not cover any complications due to those procedures either. Not all the time is that true, but many times. Something to think about...

[jensmallwood 0]

My plan was similar to the others-- and at my BMI, with no comorbidities- insurance would not cover it. So I went with self-pay. Before I did that- I did check with my insurance company to make sure that they *would* cover any complications or problems I might have. They said that they'd treat it as any other pre-existing condition, which they *do* cover. So that is something else to check into. If you have a band slip, or erosion or something- you might not have another 15K to shell out for that...

As for your other question, you will have to find a doctor who is willing to give you fills in your area. I'd call around. I think some offices will give fills to "outside patients" and some will only fill their own. I'm not sure what the protocol is for that-- I know there are "Fill Centers USA" in some places, but I don't know anything about them.