Benefits include BS

[Guest morganstarr]

I am researching the LapBand surgery and I just discovered that my insurance benefits handbook says bariatric surgery IS covered. I am blessed to have coverage under CHAMPVA (because my husband is a totally disabled veteran.)

Is having bariatric surgery listed as a covered benefit usually a good sign of early or quick approval? Or do the insurance companies still make the insured jump through hoops?

Does anyone else have any experience with CHAMPVA. (This is not TRICARE or CHAMPUS.)

Also, can someone tell me the insurance code for the LapBand surgery? Thanks for helping a newbie.

[Laura W 0]

I haven't been banded yet, I'm still in the research stage but from all of my readings so far is that just because your insurance says it covers WLS doesn't mean it's an easy road to approval. Some insurance companies are worse than others on this. So far I haven't read anything about your company though. All you can do is remit your paperwork and see what happens!

[Guest morganstarr]

Thanks for replying , Laura.

Actually, I talked to a benefits counselor this week and she said all they need is a letter from the doctor stating that it is "medically necessary." I asked if she needed certain tests, evaluations, or medical records and she said only the letter is required. Now I have to find a doctor who will take the CAMPVA coverage. It is similar to Medicare in that it has the "reasonable and customary" limits on the cost of the surgery. And, as with Medicare, the surgeon/hospital must accept assignment. Not many are familiar with CHAMPVA, so I guess if a surgeon/hospital accepts Medicare, they would accept CHAMPVA.

I have my orientation meeting scheduled with a local doctor on Monday. It's just a video and a meeting with other prospective banders. I've done so much research I think I could give a presentation!

[Guest P-38]

I too haqve an insurance company that covers Bariatric surgery. But, today I received the letter declining coverage for the Lap-band surgery as they consider it still in the "investigative state".

I haven't appealed yet as I haven't had time but it may be a battle. Any suggestions?

[Laura W 0]

P-38, it's not investigational, it's APPROVED already by the FDA and has been for nearly 4 years, I think since 2000. You can go to the Inamed website and look on how to contact them. They will help you go to bat against your insurance company on this. Hope this helps!

[Guest P-38]

Thanks Laura,

You know this and I know this. Even my dog knows this. Unfortunately my insurance says they have their own criteria to follow.

I have since found out the doctor on staff at the insurance company had never heard of it. MY doctor has appealed the decision and will talk personally to their doc next week some time. So... still not out of the question. Just a bump in the road.

Cross your fingers.

[Rebeccalee 2]

I have ChampVA and just had a consultation with a surgeon. I'm glad to hear there are no special requirements. I called and was told they could not tell me anything, the doctor had to write a letter.

My doctor was not familiar with the ins. and I just found out after my appointment (went back and read the benefits book) that they have to accept the amount VA will pay. I don't know yet if they will. I'm anxious to find out.

Email me if you want to compare journeys through the VA payment scene. : )

Rebecca rebecca@moonfrog.com

[Rebeccalee 2]

The code ChampVa gave me for the surgery is: 43843

[mlt45 0]

I am also insured with ChampVa. Thank you for this thread, I will inform my doctor's office tomorrow about the letter needed. They have never taken a patient with this kind of insurance before. I have a secondary policy also that pays 25% of what ChampVa pays after I receive my EOB.

I had my first appt. today, thank you again for the info and the code.

Marcia

[GeezerSue 7]

P-38!!!

I had you on my keychain once!!! How did you escape? We were in Germany, together, too. Do you remember any of this?

Sue