Self Payers and Insurance...

[disney38 0]

Once your insurance denied your coverage, or you just simply chose to pay for it yourself, did you tell you insurance company you were having this surgery?

I am on the fence, and very frustrated with my insurance. I guess they want me to have a stroke before they cover, but I aint waiting. My concern is whether or not I should tell them I am doing it. If there are complications later on, I heard that sometimes insurance will pay. However, if I tell them ahead of time, they may decide to be nasty.

Thanks

[disney38 0]

Wow - you are doing great! Actually, my insurance DOES cover banding, and I did jump through the hoops, and they denied coverage to ME. Why, because my BMI is 39 and not 40. If I knew then what I know now.....

I was diagnosed with sleep apnea at the sleep study. I got a CPAP and initially WAS sleeping better (only had it 2 weeks when denial came through), but the reason why it was denied was because I did not have a comorbid condition with a BMI over 35 but less than 40. They did not count the sleep apnea, as my records said "controlled by CPAP." I am now experiencing high blood pressure (not extermely high - 142/95), but if I were on medication for that (I am not), they won't count that either.

I am a bit irritated with my insurance company. I have been to hell and back in the past 7 months.

Anyway, surgeon has one week to figure out if they will fight for me. If not, I am going south - actually, have a date scheduled in Mexico if this falls through. I am not holding my breath! :cry

[Daisalana 33]

I'm same with wasbubblebutt..

I was told my insurance might cover it, but I'd have to jump through hoops. I was able to get the means to self-pay so I was not wanting to go through the long drawn out process. I just had my last back shots a week and a half ago, hoping they would last long enough for me to have my surgery and lose some weight and have less pain.. unfortunately for me, the back shots did not work AT ALL this time, so I'm in chronic pain and counting the days! I guess it depends on your situation. I don't think I can wait any longer, and I had the means. After the fact, I found out my insurance coverage would only cover GB.

[gettin skinny 0]

I am a self pay. I see it as an investment in my future. I figure it costs about the same as a good used car. I am worth more than that. My insurance stopped covering it in Oct. 2006. I will be banded 4/13.

[Trace Curry 1]

I don't see why you should tell them - if they ask I certainly wouldn't lie, but there is no benefit to you to call them up and volunteer the information!

It's your employer that doesn't provide the benefit, not your insurance company, so they are the ones that you need to give grief to.

Good luck!

Dr. C Cincinnati, Ohio

Got a question? Ask the doctor at www.TheBandDoctor.com

877.442.BAND

DISCLAIMER: If am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!

Once your insurance denied your coverage, or you just simply chose to pay for it yourself, did you tell you insurance company you were having this surgery?

I am on the fence, and very frustrated with my insurance. I guess they want me to have a stroke before they cover, but I aint waiting. My concern is whether or not I should tell them I am doing it. If there are complications later on, I heard that sometimes insurance will pay. However, if I tell them ahead of time, they may decide to be nasty.

Thanks

[NVgirl 2]

Even though my insurance does cover this procedure, I could have self-paid to speed up the process. However, I'm glad that I've taken the time to jump through the hoops to get approved - it's given me more time to learn about how my life is going to change next month and be prepared for it.

[sunnysea 1]

Wow - you are doing great! Actually, my insurance DOES cover banding, and I did jump through the hoops, and they denied coverage to ME. Why, because my BMI is 39 and not 40. If I knew then what I know now.....

I was diagnosed with sleep apnea at the sleep study. I got a CPAP and initially WAS sleeping better (only had it 2 weeks when denial came through), but the reason why it was denied was because I did not have a comorbid condition with a BMI over 35 but less than 40. They did not count the sleep apnea, as my records said "controlled by CPAP." I am now experiencing high blood pressure (not extermely high - 142/95), but if I were on medication for that (I am not), they won't count that either.

I am a bit irritated with my insurance company. I have been to hell and back in the past 7 months.

Anyway, surgeon has one week to figure out if they will fight for me. If not, I am going south - actually, have a date scheduled in Mexico if this falls through. I am not holding my breath! :cry

Disney, If your insurance does cover lapband surgery maybe all you have to do is appeal it. Sleep Apnea and high blood pressure are considered co-morbileties, I would try again. And as far as I've been told by Dr's your pressure is too high, at least that lower number is??? My ins. had it excluded even if medically nesesary so I went to Denver to a great Dr., he charges $9,500 for everything. Good Luck, sunnysea

[Fauxnaif 1]

My insurance at the time didn't cover any weight loss surgery so I went self-pay.