Pre-Auth Problems

[nesiewalker 0]

I have bc/bs and Aetna POS and neither one of my insurance cover's the lapband I called both insurance companies and gave them the code which is 43770 and they told me that they do not cover the lapbad, has anyone experienced this? What should I do still submitt it to the insurance company and go from there?

[denoly 0]

You may need to show proof of 2 morbidity issues to qualify. I have Bc/BS of MD adn the requirements are 35 BMI w/ 2 morb. conditions ie. diabetes, heart disease, sleep apnea etc. Or <40 BMI. Lucky me, I am <40 BMI AND diabetic so I had more than required. My MIL is going through the 6 month nutritional Counseling - she is borderline 35 BMI but no true Morbid conditions, so they are looking into everything to see what they can do to help her qualify. Do NOT take the first no for the answer- find a good surgeon and program and enlist their help fighting the fight! Good Luck!

[Krystle Lynn 0]

I am going through the same problem.

I have BCBS of FL through my employer. The employer(thanks, a lot), b/c of the fact that we are a small business, chose the most basic, cheapest plan out there - So there is an exclusion to the policy which states that they will not cover bariatric surgeries of ANY kind - And none of the individual plans will, either. I have been frantically and desperately searching around for someone who WILL cover the surgery - I do not qualify for financing b/c of my credit score and debt to income ratio.

I have been in touch with the agent for my insurance - the office - and am fortunate that the lady there understands my pain, or whether or not she understands it, I don't know - But I do know that she is sympathetic and is trying everything she can.

She told me that she was going to look into certain plans like AFLAC, etc. that may have some sort of ryder or to see whatever she could do to help me.

That is my suggestion to you. You can also go ahead and let the surgeon submit the request, and if it doesn't work, have his office send it in again - That would be considered an "appeal". You could call your insurance company and hassle them to death, but I don't know far that would get you, either. I'm half tempted to do it, myself.

Either way - I IDENTIFY WITH YOU. I completely get what you're going through right now and it's hearbreaking ...

Write down everything about this surgery and what it means to you to get it done. You should include any medical issues that have been a problem with your weight, and talk about the money you have spent on doctor's visits, etc. due to your weight issues. Explain that this would take care of so many of those issues, and that while it may be a large sum to look at now, in the long run, you will be healthier and they will be able to stop paying out the money they've been spending on medicines, dr visits, etc.

Hope this helps...If you find a way to get it covered, let me know.

Thanks,

Krystle

[stighe13 0]

Does anyone know what MVP requires? I have a BMI higher than 40 and a co-morbidity.

Thank You