what should i do?

lisakoenick · March 21, 2007

Thank you for your email. Dr. Barry S. Greene of Advanced Surgery PC is a participaing PPO provider with the Plan. Unfortunately, your group coverage with CareFirst does not include benefits for lap band surgery or gastric bypass.

i want to look into having lap band surgery. i am 5'3", i weigh 245, i have sleep apnea, high BP and high cholesterol as well as irregular thyroid.

i don't get how a doctor that does lap bands and gastric bypass surgeries could be a preferred provider yet the procedure itself is not covered.

anyone eaver deal with this?

I have Bc/BS PPO thru maryland.

jahair · March 21, 2007

Thank you for your email. Dr. Barry S. Greene of Advanced Surgery PC is a participaing PPO provider with the Plan. Unfortunately, your group coverage with CareFirst does not include benefits for lap band surgery or gastric bypass.
i want to look into having lap band surgery. i am 5'3", i weigh 245, i have sleep apnea, high BP and high cholesterol as well as irregular thyroid.

i don't get how a doctor that does lap bands and gastric bypass surgeries could be a preferred provider yet the procedure itself is not covered.

anyone eaver deal with this?

I have Bc/BS PPO thru maryland.

I am definitely NOT an insurance expert, but I can speak from my own experience and maybe it applies to your sitiuation. When I looked into having my husband's insurance company cover my surgery I found that weight loss surgery was excluded. The insurance company provides coverage for weight loss surgery but his company doesn't offer the benefit. This means that when the company signed up for the insurance policy they opted not to provide benefits to their employees for weight loss surgery. Another company may have the same insurance policy but have no exclusion for weight loss, so their employees can receive the surgery.

Do I think it sucks? You bet! But there is no appeal if the company says it doesn't want that surgery covered. So your doctor can very well be a preferred provider and would be yours, if the employer had said yes.

This puts you into the land of self pay and you can search for references to that process on this forum. Everyone handles it differently.

Good luck on your search. You know now that the road to the surgery has a few twists and turns, however, your commitment to the goal will be what ultimately sees you through.

Jo Ann