Insurance Issues with Fills

[ohlalauren 0]

Hi,

I was just banded on March 10th but feel very little to any restriction at all. This is even when i introduced solids. It's hard to know when to stop eating but I never eat more than 3-4oz at a time and eat slowly. I feel completely unsatisfied all the time, and told my doctor that I need a fill. When I told him, he said that my insurance (Aetna) would not cover the costs of a fill for the first 90 days and if I wanted to have it done, it would cost about $500 out of pocket. Is/has anyone else had this problem?

[Teacher07 3]

Hi,

I was just banded on March 10th but feel very little to any restriction at all. This is even when i introduced solids. It's hard to know when to stop eating but I never eat more than 3-4oz at a time and eat slowly. I feel completely unsatisfied all the time, and told my doctor that I need a fill. When I told him, he said that my insurance (Aetna) would not cover the costs of a fill for the first 90 days and if I wanted to have it done, it would cost about $500 out of pocket. Is/has anyone else had this problem?

$500.00???????? wow try to find a different place to get a fill. Even without insurance I think my fills are $195.00

[ElfiePoo 109]

I'd call Aetna and find out why and ask them why they would delay the very thing you need to make the band work. Perhaps they're uninformed.

My doc only charges $150 for a fill for people with no insurance coverage.

.

[adagray 1]

I would definitely contact Aetna. I have Aetna too and it seems that a lot of the people who work there don't really understand the band and how it works. I had a situation where Aetna dropped my surgeon as an in-network doctor and told me I needed to go to a different bariatric surgeon for my fills. I called and explained that I did not feel comfortable switching this closely after surgery and I got another 3 months approved w/my surgeon so I can hopefully get to proper restriction (or close to it) before I have to switch doctors. They were very nice on the phone, but just uninformed. Once I explained the whole thing, they approved my additional follow-up visits the same day. They called me back and gave me an approval number just two hours later.

I would bet that they assume the first 3 months of fills were included in the surgery charge. This is how my doctor does it. So, all my fills were free and not charged to my insurance and no co-pay for the first 3 months after surgery. If this is what Aetna is assuming then the insurance person at your doctor's office needs to talk to someone at Aetna and explain that for their program, its not included. Or, your doctor should learn to charge Aetna more for the surgery and include it. Its so confusing. Every doctor and every insurance is different.

But, ultimately, what it comes down to is you have a medically necessary implant that will not function without these adjustments. Since Aetna paid for the surgery (deeming it medically necessary), the fills are medically necessary as well and one way or another, they need to pay for those.

[lindas0809 0]

I would definitely call Aetna. I had Aetna HMO and they covered fills 100% for the first 90 days and they I paid a copay and sometimes a balance of $50-70 that was billed after.

You definitely need a fill for the band to work, so do what you need to do to get them.

[bandedwls 0]

Hi,

I was just banded on March 10th but feel very little to any restriction at all. This is even when i introduced solids. It's hard to know when to stop eating but I never eat more than 3-4oz at a time and eat slowly. I feel completely unsatisfied all the time, and told my doctor that I need a fill. When I told him, he said that my insurance (Aetna) would not cover the costs of a fill for the first 90 days and if I wanted to have it done, it would cost about $500 out of pocket. Is/has anyone else had this problem?

i was banded jan. 22 and i know how u feel. it is a challenge and u will over come this u can wait for the 90 days. i didn't have a fill yet and this is stressful. my stomach growls and talks when i am not hungry. i am hoping to have a fill April when my insurance starts.