Called My Ins Company Today And Was Told It Is Covered With Authorization?

[TrishT 0]

Hello,

I became curious about the lapband lastnite so found this forum and was wondering about my insurance, i live in TN and i have what is called TNcare ...americhoice, so i called them this morning and ask if lapband is covered and he said yes with authorization..so what is my next step? Ive never talked to my doctor about this because didnt figure insurance would cover it, but i do have an appointment early may for a meds check up so should i ask about it then? And how willing is a dr to say yea you need it?

Thanks..Trish

[NWgirl 574]

authorization means that the surgeon who will be performing the surgery submits for pre-authorization from the insurance company. The insurance company will then decide based on what is submitted if the surgery is medically necessary.

some insurances require a 3 or 6 month supervised diet, so I would call back ans ask what the specific requirements are.

[TrishT 0]

I did ask about the supervised diet while on the phone because i had read about it on this forum and he said that there is no superivised diet.

[brokenwings 98]

I would check out surgeons you think you may want to use. THen i would call and find out if they have a seminar coming up you could attend.

[difa 114]

Good Luck!

[Dawn200321 146]

My Dr. agreed that it was a good idea. He just went through some of the risks and statistics with me. After I explained to him that I had done extensive research he told me I was a great canidate! Now on the flip side I knew one woman who wanted to get it done and her dr told her no way would he approve of that. So I guess it really depends on the Dr.

[TrishT 0]

who actually determines if you can benefit from weight loss surgery, your primary care dr or the surgeon? Do i need to see a surgeon right off or talk to my pcp first?

[NWgirl 574]

if you have been with your pcp for a long time, it would he good if they would write a letter saying it's beneficial. The insurance company is actually the one who reviews and decides if it's medically necessary.

some insurances also require you go through a center of excellence. It's best to get as much information backing up your struggle with weight loss. I got a letter from my pediatric Dr who I saw from birth-20 (I am 23 now) showing growth chart and diet attempts. I also wrote up a list of diets i've done over the years. The more you provide the surgeon with, the more they send to insurance, and the more likely you are for approval.