Determined To Have The Band

[Amy M 0]

Hello,

I Am New To This Site. I Have Been Thinking About Joining For A Month. I Finally Did It Because I Have Decided That The Lap Band Is For Me. My Problem Is Not Knowing Whether Aetna Pos Ii Will Cover It. I Can't Seem To Find Out If My Company Excludes It Or Not. I Have Asked My Company 2x And They Don't Know What I Am Talking About. They Said Call The Insurance Company And Ask. I Did Call And Aetna Said They Cover It But It Depends On My Company's Policy/benefit Plan. If It Is Excluded I Want To Know Before I Start The Process Here In The States. If It Is Not Covered, I Am Determined To Go To Mexico And Have It Done By Dr. Ortiz In Tj. I Guess My Question Is, How Can I Find Out If My Benefit Plan Has An Exclusion Clause? Also, How Is Dr. Ortiz And How Difficult Is It To Get Fills? Please Help. My Appointment Here In Ny Is On January 10th With A Wl Surgeon.

[bandiva 0]

Dr. Ortiz is awesome. You can read about my experience on "my life as a bandster". I wrote about how it went etc. I know that on the 'babygotback' journal she has a lot of info on Dr. Ortiz. I am just arranging my first fill, so hopefully it is not difficult at all. Best Wishes.

[kwhenrykerr 0]

Loved the doctor, fill are easy

[TracyinKS 7]

Ok go to your Human Resources Department, ask the person who knows the most about your benefit plans.. ask to see a copy of your medical SPD, which is also called a PLAN DOCUMENT, this is usually a big book of mumbo jumbo details that could put you to sleep in a heartbeat.. LOL, but a provision or exclusion for bariatric surgery is in there.... if this does not work, ask your benefit person to contact the main benefits person at your CORPORATE OFFICE.. they will know.... don't be intimidated about doing this, they are just people who get paid the big bucks to KNOW what is covered or not........

It is true... the insurance will cover what your company ALLOWS them to cover, but really it sounds like you are getting the low level run around..... you need to be proactive about nailing down the details.

I will say this .... I am the HR person for my company, and I am the go to person for all the employees.. I myself HAD NO CLUE THAT WE COVERED IT.. not until I went to a train the trainer meeting where I actually had a one on one conversation with the VP of HR for our corp office...... so it can happen to the best of us.... just push for the answer and don't feel bad about it OK?:biggrin1:

[Kellie/Iowa 0]

Hello everyone, my name is Kellie and I am getting banded with Dr. Ortiz in TJ on thursday, I have about 4 days until surgery, (OMgosh I can't believe it's that soon) I am very excited to be doing this. Just thought I would introduce myself and wish everyone a Happy New Year. I live in Iowa, so not alot of people in this state have been banded in Mexico or even been banded at all, mostly gastric bypass around here. Anyway, I am totally excited and am taking this journey alone, so hope to meet anyone who is having this done there around that time. I haven't found anyone who is having the surgery on my surgery day (on this forum or the other I am on) BabyGotBack, I see you are scheduled the day after me. So good luck maybe we'll run into each other while there.

Kellie

[Amy M 0]

I want to thank you all for responding so quickly. It can be so confusing with insurance issues. Even if my insurance covers it, i am tempted to just go to Mexico and avoid the hassel. I have a very good feeling about Dr Ortiz, just not sure if i can get a loan. Have a happy new year to all of you!!

[CP-Mike 0]

I want to thank you all for responding so quickly. It can be so confusing with insurance issues. Even if my insurance covers it, i am tempted to just go to Mexico and avoid the hassel. I have a very good feeling about Dr Ortiz, just not sure if i can get a loan. Have a happy new year to all of you!!

?!

Why? Even in Mexico it costs thousands of dollars...

Some insurance companies will do what is called a pre-authorization letter. Perhaps you can ask for that, or like the other poster said, just find out who the Sr HR person is.. just be polite but firm. Their ignorance should not cost you $1,000s. Part of your total compensation from your work is health care, it is your right to know what is/is not covered.

Or find a Bariatric specialist group you want to work with and speak with their insurance experts. They have them and they want to help you.

Fight the good fight with your head held high! These are the first steps of the journey of your new healthier life.

Good luck!

Mike

[kwhenrykerr 0]

Good Luck with the Doctors office helping with the Insurance. When my girl had her bypass done the doctors office was not very helpfull, lots of smiles that were a put on. She had a US doctor who acted like a god.

Dealing with the insurance company was a pain in the ass. But we got it done and now she is almost 200 pounds lighter. I went the Lap-Band route and avoided lots of the trouble she had. I am going for my second fill in the morning. I am happy with my band, my weight loss and it has been the right thing for me.

I wish you good luck, keep working with the insurance and hr people, it's worth all the effort.

[juliegeraci 7]

You should be able to go straight to the insurance company and have them answer that. They can look it up for you. My fills are not covered. Good luck.

[skyeblu79 0]

I have UHC and I was able to just go online to find out what exclusions there were. I didn't want to tell my HR manager about the surgery, so I looked it up myself. Your insurance company probably has something similar. Also, when I called the insurance company directly they told me my specific company plan didn't cover the surgery.

[Amy M 0]

Hi everyone,

I still don't know if i have an exclusion policy. I talked to two people from HR today and they said they would have to look into it because they have no idea...uhg! What does an exclusion policy say exactly?? I have heard the language can be tricky.