Is the answer really NO, or do I have any options?

[lyndeeboo 68]

I hate to be a whiner, and normally I accept when I'm defeated, but before I give up before I've even began I want to be SURE this is the end of the road with my thoughts of having LB done.

I have Blue Cross Blue Shield of Texas. I just made a quick call to see what my coverage would be with lapband and was told point blank, (in a nice way!) that the procedure, nor any other obesity or morbid obesity treatment would never, ever be covered, at all. :thumbup:

So is that it? Is there any way to protest when it's not that I was denied a particular procedure, but that they don't cover it, ever?

I'm just so sad and deflated.

Does anyone know what the procedure costs out of pocket? Would insurance EVER cover refills and adjustments if I paid for the procedure out of pocket, or would those too be out of pocket?

[Mariasha 3]

Out of pocket in the USA is anywhere from 10 to 15K or more.

In Mexico I believe you can get it for significantly cheaper.

I was a self pay here in the US and have absolutely no regrets. My life is worth a lot more than the money I spent.

[HappyMom 1]

I would call your employer health benefits department. BCBS as a company covers weight loss surgery ONLY if it is a benefit allowed by your employer. Some employers put limitations on certain coverages to allow for lower premiums. I personally have BCBS and they covered my surgery....but my employer allows such coverage. A friend of mine with BCBS, that works for another company, couldn't get hers covered because her employer has a weight loss surgery exclusion in their policy that they provide their employees.

If you are looking to get it done out-of-pocket I would check out Dr. Adam Smith in the Dallas/FW area. He actually performed my surgery here in New Mexico (comes over once a month to do surgeries in ABQ). He mentioned that the surgery in Texas is about $9,900.....here he performs the surgery for $15,000. There are self-pay patients here in NM that are going to Texas to have him perform the surgery because of the difference in price. I would highly recommend Dr. Smith.....he is a great surgeon who has actually had the LapBand placed on himself a few years ago.

I really wish you a lot of luck with your dealings with your health care. I am NOT a fan of health insurance companies and the hoops that they make you go through to get pre-approved for any surgery. Again, call your HR department and see what they include and exclude from their plan with BCBS.

Good luck and best wishes!

[Amanda1982 142]

I was looking through my packet for the information for you. My surgeon ‘s packet says $14,500 for self pay. Good LUCK

[lyndeeboo 68]

Thank you for your replies, I really appreciate all of you! You've definetely given me some great information. My hubby's open enrollment is about to begin with his employer. I think I will check into his insurance and *IF* they cover the procedure it may be worth the extra money to add me to his insurance.

Now another question: Since his insurance will be my secondary insurance...anyone ever had to go through that fight?!?! Will the secondary insurance cover me, or is that automatically a good reason to deny coverage?

[Cocoabean 430]

As to post-op care when self-pay. If you do not have coverage for the surgery, the insurance company likely will not pay for adjustments.

If you have a complication, the insurance company should pay for that. I am not sure how much of a fight you would have on your hands as to where they would draw the line as to what is a complication or not.

However, if money for after-care is a big issue, here is some food for thought: While most fills happen in the first year post-op, and many doctors include a year of fills in their surgery price, you might have to pay for more fills after the first year. If you went with a gastric bypass or sleeve you would not have those expenses.