Covered Or Not

[troublemaker 0]

Looking at my employee hand book, weight loss programs are not covered.....Duh! With that being said is the Lap Band procedure considered a "Weight Loss Program"?

[MelindaH 3]

yes, I am afraid it is....well, now wait a minute. It is a surgical procedure...but probably what your benefit book is referring to, is that it does not cover any surgical procedurer with the diagnosis of obesity.Typically weight loss programs are weight watchers, jenny craig etc.

[running_scared 125]

It would be an insurance thing, as opposed to an employer program, wouldn't it?

[Dulci 108]

Call your health insurance company, give them your ID number and ask if you would be covered for the procedure. Some employers opt out of WLS coverage to reduce insurance rates, so ask if it would be covered for you, not just if they cover it.

My employers policy covered WLS, but does not cover diet programs like WW or Jenny Craig, even if it is a medically supervised program.

[Humming Bird 275]

It would be an insurance thing, as opposed to an employer program, wouldn't it?

Employers can opt out of the different types of plans that cover WLS to save money.

[troublemaker 0]

Wel, my doctor ran a pre auth. to my insurance, and I was aproved for a "full bypass" but not the "lap band" because it is considered a weight loss program. Now, I went to my insurance web site and logged in and put in what procedure is was considering "lap band" and what their web site said was... I was covered 100% for the "lap band". So I went back a page and put in "full bypass" I was also 100% covered. With that said, who is right?

[Holly Dolly 575]

I would trust what you found on the internet over what the dr received. I deal with dental insurance and I see so many things denied, saying it isn't a covered benefit. I then have to call and have them reprocess the claim. Hopefully this will be the case with you too. Good luck!

[MeredithMcFee 98]

Call the dr's office and ask them for the CPT code {computer procedure code} and ICD.9 code {diagnosis code} used for the lapband surgery. The codes describes the particular procedure and the reason for it. Call your insurance company and ask them if those codes are covered under your program. Ideally, try to find a surgeon who participates in your plan so as not to have to put any or little money out for the surgery. After that, if you schedule with a surgeon, you'll be required to go through pre-op testing with other specialists. Do your homework and find a specialist who also participates with your insurance to keep any additional costs down.

Good luck.

[troublemaker 0]

^{Well called my insurance company and they told me that the lap band is not covered but full bypass is. Then I asked them about what their web site said and they couldn't answer me!}

[MeredithMcFee 98]

^{Well called my insurance company and they told me that the lap band is not covered but full bypass is. Then I asked them about what their web site said and they couldn't answer me!}

I would ask to speak to a supervisor. I work in medicine and understand how that all goes. Until you hear it from someone higher up, I wouldn't stop there. Good luck.

[troublemaker 0]

They also told me that it was due to the elections that my employer choose while setting up our new insurance. So my employer opted out of the lap band, but opted in for full bypass.

[MeredithMcFee 98]

They also told me that it was due to the elections that my employer choose while setting up our new insurance. So my employer opted out of the lap band, but opted in for full bypass.

I'm sorry. It sounds like you exhausted all avenues.

[troublemaker 0]

Ok here we go again! Called Rengecy BCBS again and talked to somebody that knew what was going on. What they said is if the facility Is a " Center of Excellence" facility and deam it medical nessarsary to have the lap band done over the full gastric bypass, they can request the lap band be done instead! So I called the surgeon's office and told them that, and the said they are a "COE" facility but they have never heard of filing an appeal in the case of the lap band being excluded from the insurance policy. So maybe we have a chance!

[MeredithMcFee 98]

Ok here we go again! Called Rengecy BCBS again and talked to somebody that knew what was going on. What they said is if the facility Is a " Center of Excellence" facility and deam it medical nessarsary to have the lap band done over the full gastric bypass, they can request the lap band be done instead! So I called the surgeon's office and told them that, and the said they are a "COE" facility but they have never heard of filing an appeal in the case of the lap band being excluded from the insurance policy. So maybe we have a chance!

Great News here! If I learned anything from my former Employer/Dr, never take "no", "don't", "can't" etc. etc. for an answer. If any of us came back to him re: negative's here, his saying was always, "that's not acceptable". haha. Back to the drawing board we would go and 9 times out of 10, exhausting all avenues, he would get a "yes we can" response. Keep on top of the coordinator to follow through and get the appeal out asap. After all, it's a win-win for you and the surgeon to have the surgery done. Good luck and keep us in the know.

[dmlawyers1 0]

I'd believe in that which you on the web more than exactly what the actual doctor obtained. We cope with dental care insurance coverage as well as We observe a lot of points refused, stating it's not the protected advantage. When i need to phone and also have all of them reprocess the actual declare. Ideally this is the situation along with you as well.