Question - insurance denied - self pay?

[mama angela 22]

Hi, So, my insurance was denied again.. I did my 6 months visits with the nurse, nutrionist and physical therapist...my doctor referred me to that program and then they emailed her as we were going along. I had asked if I needed to see the doctor each of those months too...and they said no. So, in May...after my 6 months...the surgeon submitted for pre-approval and I was denied! The insurance said I should have met with the doctor each of those months also. I did an appeal...with all the paper work as the insurance did not state that I had to in the beginning. They just denied it again...and now they are saying that if I do another 6 months and lose weight that the surgery can be denied! Ugghhhh.

So, my question...well...one of a couple..:-) If I restart now...my 6 months will be in December. I have met my $2500 out of pocket for this year already and next year my company is going to a new insurance. (That is if I still will have a job there). So, I could restart meeting with the doc, nutrionist and physical therapist...I will have a problem getting to appointments in Sep, Oct and Nov...as those will be 12-14 work days through budgets. My concern is that I NEED to lose weight now. I'm on bp meds, cholesterol meds, need surgery on my knees, type 2 diabetics and have sleep apnea. So, if i do that and start to lose any weight then the insurance can deny.

I'm seriously thinking of seeing if I can take a loan for the surgery.

Also, I have a small hernia that doesn't need repair...but does anyone know if the doc would repair that...having the insurance pay for the anesthia and stuff and I just pay for the lap band?

thanks!

[pinklily27 61]

Not sure how your insurance will work. I had a hiatal hernia that developed about 10 months into my band that caused my band to slip. The surgeon took me in to fix the hernia and repair the band, which ended up needing replaced. My insurance paid for everything but the actual band in that procedure. I think it had to do with the way he coded the procedure.

[labwalker 1,177]

My doctor had a problem placing my band, and time under anesthesia was longer than expected... that set off a chain of events where the insurance was billed for extended operating room time, and I had to argue to get the extra time approved. They may cover the hernia repair, but they also probably also base payment on a fixed amount of time in the OR. This is something you have to be careful about, and research carefully. So sorry to hear that you were denied!!!! That seems so unfair.

[mama angela 22]

Thanks. Sinnce he had said he would repair the hernis while he was in there...I thought maybe he could reverse and put the band in while doing the hernia fix...:-)

I think I may look at taking a loan.

[kbush 176]

Hi' date=' So, my insurance was denied again.. I did my 6 months visits with the nurse, nutrionist and physical therapist...my doctor referred me to that program and then they emailed her as we were going along. I had asked if I needed to see the doctor each of those months too...and they said no. So, in May...after my 6 months...the surgeon submitted for pre-approval and I was denied! The insurance said I should have met with the doctor each of those months also. I did an appeal...with all the paper work as the insurance did not state that I had to in the beginning. They just denied it again...and now they are saying that if I do another 6 months and lose weight that the surgery can be denied! Ugghhhh.

So, my question...well...one of a couple..:-) If I restart now...my 6 months will be in December. I have met my 2500 out of pocket for this year already and next year my company is going to a new insurance. (That is if I still will have a job there). So, I could restart meeting with the doc, nutrionist and physical therapist...I will have a problem getting to appointments in Sep, Oct and Nov...as those will be 12-14 work days through budgets. My concern is that I NEED to lose weight now. I'm on bp meds, cholesterol meds, need surgery on my knees, type 2 diabetics and have sleep apnea. So, if i do that and start to lose any weight then the insurance can deny.

I'm seriously thinking of seeing if I can take a loan for the surgery.

Also, I have a small hernia that doesn't need repair...but does anyone know if the doc would repair that...having the insurance pay for the anesthia and stuff and I just pay for the lap band?

thanks![/quote']

Did you try true results?

[mama angela 22]

What is true results? Is that who I could get a loan thrum?

[kbush 176]

What is true results? Is that who I could get a loan thrum?

Google them. They do weight loss surgery.

[Cwalband 215]

My time trying to get approved with insurance has been about 1.5 years. After jumping through hoops I was finally approved. Also I went through True Results that say they are experts in working with insurance. I'd see if there is one in your area maybe they can help you. Hope everything works out, I understand the need for the surgery as I have felt the same the last 1.5 years. So hopefully if its insurance or self pay you will be on your way soon! Best wishes!

[mama angela 22]

Ahhh...I just looked them up....looks like they are in Texas and Arizona. I'm in Idaho.

[Cwalband 215]

What is true results? Is that who I could get a loan thrum?

The True Results that I went through did have loan options and low monthly payments etc. For sure check them out!

[Cwalband 215]

Ahhh...I just looked them up....looks like they are in Texas and Arizona. I'm in Idaho.

Maybe try checking with a Lap Band Doctor who offers payments. My doctor does payments but I was ultimately covered by insurance. I'd say keep doing research.

[HotButterFly 981]

A friend once told me the "trick" is to lose a few pounds one month, and gain them back the next.

[Soulshine76 11]

I went through care credit. They have interest free options.

[mama angela 22]

Thanks I will look into those options. I will talk to the surgeons office tomorrow...and check out carecredit.

[NWgirl 574]

I did not need to take out a loan for my band, but I do have CareCredit for other medical/dental expenses and they work great for me.

I have heard of Dr's just charging the patient for the lapband if they have to do a repair such as hernia, gallbladder, etc at the same time. If your insurance will pay for that type of surgery, it couldn't hurt to ask the surgeon if you could pay for the band placement and the insurance pay for all costs associated with the actual hernia repair.