Strike 1

[shan2321 0]

Ok, so I'm scheduled to go to a seminar on Thursday so I figure I'd call my insurance this morning to find out what the process is (because I know they cover the procedure in general). Well the moment I said lap-band and gave her my member #.. she said my group (basically my employer) doesn't cover it! I'm so pissed off right now. Not only do i pay over $400 a month for family coverage, but they think it's better to pay out on all my other issues (diabetes, high cholesterol, had my gallbladder removed, etc.) than offer this one surgery. seriously... B.S.

I have an email in with my benefits coordinator to see if there is anything that can be done or if the other insurance my company provides would cover it... so we'll see if anything.... Man, I'm not a foot out of the gate and BAM! Brick wall. How depressing.

For those that have financed the surgery, what were your average total costs? What about having done in Mexico? What about those ads you see on the right of the forum screen?

All advise would be greatly appreciated. I gave up once, but I have to have this done this time. I have to make it work. TIA

[jsea 3]

Hello TIA. Unfortunately my insurance doesn't cover any weight loss surgery so I am a self pay. I am getting lapband with plication surgery and the total cost for me is $16,500. I am sure the cost will vary based on the doctor you go too. Although part of me was extremely angry that my insurance didn't cover it, I was almost glad in a way because I didn't want to wait 7 - 10 months going through everything insurance requires to get the surgery. I saw my doctor on August 9th, completed all the testing on Aug 11th (including meeting with the nutrisionist), was cleared for surgery on August 12th and am scheduled for surgery on August 29th. Hope that information helped answer some of your questions. Best of luck to you!!!

[shan2321 0]

That's very helpful. Thank you! Does that price include hospital stay, aenestesia etc?

Got a response from my benefits coordinator....

You are correct, this is not covered by CHP, nor is it covered through BCBS. Majority of insurance companies will not cover the surgery anymore even if it is medically necessary.

CHP does have free Diabetes Prevention and Weight Management Program for CHP Members.

Basically meaning "I don't have an answer and that's just how it is, here's the lame program that they do offer instead that doesn't work"

Grrrr..... I'm going to keep asking questions until they can offer a real reason.. and in the meantime I guess I'm just going to have to price out options...

[jsea 3]

Yes, for me this includes the anesthesia, surgery, over night hospital stay and three fills. I have Health America. Prior to me landing my doctor, I priced out other doctors for lapband (without plication) and the cost ranged anywhere from $18,000 - $20,000. There is a bit of leg work you need to do on your own but since you are paying yourself it is obviously worth it to find the best doctor with the best pricing as well.

[Jim1967 3,569]

Hi Tia,

I would definitely keep after your insurance company. They must have an appeal process. I admit I am just beginning myself but I am already gearing up for a fight with my insurance company. I have Cigna Open Access Plus and I found a document (buried deep) on their website stating they would pay if certain criteria was met and it being medically necessary.

I am attending an initial seminar and plan to follow up with the Surgeon's people. I am hoping they will get behind me and help push the insurance company....

I would keep pressing all the while following up on pre-op stuff.

Good Luck, Jim

[abowman1984 1]

I have Anthem BCBS, so that is not true, they do pay for it. I just submitted it to my insurance company through work and was approved. Of course I had to join a program with my surgeon which was $300 out of pocket, it did take about 4 months for everything. It was submitted to my insurance company and approved in 2 weeks and it was deemed medically necessary. I would try again also a lot of surgeons have a care credit you can apply for and get approved to self pay that way. Best of luck to you!