Insurance

[bevbhart 0]

Does Insurance pay any on the surgery

[tonya66 13]

Depends on which insurance you have, and if your employer has written an exclusion for WLS in it.

I would call your insurance and ask them if they cover Lap-Band surgery, and if there is an exclusion.

I have United Health Care, no exclusion was written and I found out yesterday I was approved. They required a 40 BMI and mine was 41.2.

[bevbhart 0]

I have Aetna. Is there a weight you have to be to qualify?

[tonya66 13]

Call Aetna, and ask them if they cover CPT 43770. Most insurance requires a 40 BMI, your BMI can be figured here: http://www.nhlbisupport.com/bmi/

It depends on your height and weight. Some insurances will cover you if your BMI is 35 or above and you have some existing problems, diabetes, High blood pressure, etc.

[bevbhart 0]

I am 4'11 and I weigh 220 lbs

[tonya66 13]

Based on that, your BMI is 44. You would qualify for surgery, now you just need to find out if your insurance will pay for it. Call them and ask if they cover it.

Then seek out some information thru local seminars in your area.

Good-Luck.

[Alexandra 55]

Bev, you really have to call your insurer to find out if they cover bariatric surgery in general, and then lap-banding specifically. You are medically qualified, with a BMI of 44, but every policy is different and we can't say whether yours will pay.

[bevbhart 0]

How do you check or find BMI

[tonya66 13]

How do you check or find BMI

Your BMI is 44.4

[juliegeraci 7]

I have United Healthcare. They covered 100%.

[JDru 0]

I have Aetna too and their general policy is that they will cover lapband if it's "medically necessary." You should call them to see if your specific benefits cover lapband surgery and also ask for the criteria for coverage. They want to know your medical history (5 years of being overweight, co-morbidities like bigh blood pressure, diabetes, joint pain, etc), a medically supervised diet for at least 6 months, blood tests, psych eval, nutrition eval. It takes awhile to get everything together but it's worth it. Once I submitted everything, I was apporved in about 3 weeks.

I've heard that some people have had a hard time with Aetna if they have Aetna HMO. I have Aetna PPO/Managed Care so I don't know if that makes a difference.

Good luck!