Getting Started With Insurance

[venessa 1]

I'm very new haven't even been to the doctor yet about the lapband . What I was wondering is do I need to have my doc refer me to a lapband specialist ? Do I call my insurance first before seeing a doc ? What do I ask the insurance company ?

[SoccerMomma73 1,867]

Call your insurance company first and ask if they cover weight loss surgery at all and if so what are the requirement (co-morbidities, 6 months supervised weight loss, etc) some companies have an exclusion and will not pay under any circumstances, some are easy and simply require a letter from your doc stating this is in your best interest. After that, if covered or you are willing to self pay make an appointment with your PCP. Prior to that sit down and write a list of all the diets and exercise programs you've tried and a list of all the physical and mental/emotional problems you have because of your weight (the obvious like high blood pressure or diabetes, and the not so obvious like back or knee pain, fatigue, depression, etc). The more ammo you have, the better!!! Also, shop for a surgeon. I went with the one who is 'supposed to be the best in the area' and he and I just don't mesh, wish I'd chosen someone else, particularly now that i have had major problems.

Best of luck as ou begin your journey!!!!

[Gigi_Girl 77]

You could start in one of a few places.

Ask your primary care physician's office contact your insurance company for prequalifiers and recommendation of a weight loss surgery physician.

Contact your insurance company to see if weight loss surgery is covered and what the prequalifiers are.

Identify a surgeon and go to their seminar. This is a good way to learn about the surgery and the process. While insurance policies are different, there are more similarities than differences.

There is a lot of information online. Google the procedure and/or go to You Tube for testimonials and/or actual surgeries.

This forum is great for questions and comforting one another.

Let us know if can help you.

[venessa 1]

Thank you for the fast replys I have been thinking about this for years and came to the conclusion that this what I need to do to be healthy for my myself and my family

[NWgirl 574]

1. Look at your benefits book and see what is covered for obesity treatment. If it is not covered, it will say something like "excludes any surgery for weight related" issues.

2. If it is a part of your plan, then you will need to find out what exactly you need to have (high BMI, comorbidities) to qualify for surgery. Some plans require a supervised 3 or 6 month diet. Also find out if you must see a Center of Excellence Dr- some plans require this.

3. Find a surgeon who takes your insurance and is covered by whatever specifications set forth by insurance. I recommend a center of excellence, even if it is not a requirement, because they have an all-in-one staff with surgeon, nutritionist, physical therapist, and psychologist. Also, try to find a Dr who does not charge a program fee- some do this to make more money and insurance will not pay.

4. Gather records documenting weight for as far back as you can. This will help to show insurance your history of obesity. I even contacted the Dr who treated me from birth to teens to get weight records showing early obesity. Some plans also require 2 to 5 year proof of obesity above either 35 BMI with comorbidities or 40 BMI with none.

5. As part of my insurance requirement, I had to assemble a list of all diets I'd ever been on, the length of diet (mm/yy-mm/yy) and how much weight I had lost (estimated). This may be something to do regardless and include with your pre-authorization paperwork.

6. Complete all testing as required by insurance and/or surgeon. Some surgeons require sleep tests, etc as mandatory things whereas insurance does not.