just found out its covered by my insurance

sara · February 6, 2004

hi yall , i need some opinions on this ......... when i went to the seminar for the band ...... the doctor was giving us heads up on some of the insurance companies they have dealt with and their expierences on who pays and who doesnt .......... well i can afford to pay for the surgery myself , so i just didnt even try to see if insurance would , i guess in my mind i didnt want to wait ... especially since i was scheduled 16 days after my first drs visit ....im scheduled to have the band on 2/13/04 , i called bc/bs hmo yesterday , just to see if it was covered , they said yes it was , all i need was a note from my primary doc suggesting that this would be a good thing for me to have for my health ...... that wont be a problem , i have an appt today and he is all for wls .... my question is , i dont want to wait , im going to be banded next friday , in anyones exp , have you been reimbursed after the surgery ?? and this is the big question , obviously my docs letter has to go in front of the board of bc/bs to be approved , they say that they require past diet exp failures and stuff ,. i dont have that kind of stuff . we are talking like my whole life and im 33 , thats not the kind of stuff you save ........... nutrisystem reciepts?> Optifast stuff , what do i need , the boxes from ww meals ???? i want to try to push this as fast as i can , i have a week to see what happens , i guess im just looking for opinions , especially about the reimbursement after surgery ............. any info would be greatly appreciated .......thank you :confused:

sara

Alexandra · February 6, 2004

Hi Sara,

Whew! You certainly sound motivated! I can tell you that with an HMO it's tricky to be reimbursed after the fact. What you pay for the surgery will bear no relation to the amount BCBS would have paid for it if you'd gone down their road and been approved in good time. So even if they did reimburse you later you wouldn't get anywhere near what you paid out of pocket.

So how important is the money to you? It's not very hard to show past diet failures if you have a cooperative PCP. I didn't have any actual "proof" of anything, just a long letter detailing my life of failed attempts. My PCP had diagnosed me with MO months before I applied, and said she'd been working with me continuously to try to manage my weight.

If you were told the procedure is covered, you have a very good shot of having it paid for if you qualify. But getting qualified can be a time-consuming and frustrating process. Yet when thousands of dollars are at stake, it may be worth it to try.

So the bottom line is I wouldn't place any bets on being reimbursed after the fact. Doing that goes outside of most HMO's procedures and they will probably just refuse on those grounds alone.