Not Covered....

[kari_berry 0]

Hello Alexandra & GeezerSue - Yes I checked to see if my coverage policy was online. It is actually located on our website for our company. My aunt who works in HR said that they do not hand out booklets with the information, because it is on our website - and we are able to print out pages from there. (The website is actually where I got the information from.)

Even though they said the procedure is not covered - I too belive that there is a loop hole. So I decided to start doing a little research on a surgeon here in Michigan, and I believe I may have found one.

Her name is Dr. Zoe Deol. I was checking her background in this type of procedure, and found out she has performed over 200 lap band surgeries. Her background in bariatrics is amazing. She does have some seminars coming up in October, so I am going to make a point to attend one of them, and get more information.

Still - in the near future, I will be making an appointment to see my PCP.

Before I go - I found something on www.michiganbariatrics.com - that states the following (under their Insurance section)

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"At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the procedure. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. And while insurance coverage for weight loss surgery is widespread, it often requires a lengthy and complicated approval process."

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Is there a way that you can find out whether your state has passed this legislation that requires insurance companies to provide benefits for this procedure? I read it over, and over, and was just curious about it...lol. If no one knows - that's okay. Thought it was worth a shot to try and find out.

Thanks again for all of your help. You are all so wonderful!

~ Kari ~

[New Hope 37]

Kari, your best bet is going to be calling your insurance company direct. They should be able to answer your ?? There are other bandsters here that have used Dr. Deol. Try the "Search" for her name. We'll be waiting to hear what you find out. I'm crossing my fingers, eyes, and toes for you -- that it will be good news!

[GeezerSue 7]

From the little I've read--and Alexandra is the expert here, not me--it looks like your insurance DOES pay for bypass surgeries, for the morbidly obese, probably with documentation that you have jumped through certain hoops. The next item is to see if they even mention LapBand or "adjustable gastric band," anywhere in their literature.

They may say that they consider it experimental. (Which is stupid, but some companies till get away with that approach.) They may say that they pay for it only with certain physical conditions being present. Or they may just pay for it!

Find out what the starting point is and don't geive up too soon and don't assume they'll pay for it and then get depressed if they don't. It's a step-by-step process.

[kari_berry 0]

Thanks for the replies New Hope & GeezerSue

Yes - I will still call my insurance company today and see what they say. I was just getting antsy (sp?) over the weekend and thought I'd read their book lol.

I definatly know not to get my hopes up. This is something that I believe I want done - and I know it will take time. I'm sure there will be instances where they will deny me. I'll get through it.

I'm even thinking of other options if I am denied several times, like self pay, ect...

Thanks so much again for your knowlege, and support!

~ Kari ~

[Alexandra 55]

Is there a way that you can find out whether your state has passed this legislation that requires insurance companies to provide benefits for this procedure?

Kari, your state's Department of Insurance can tell you if there are state mandates about coverage. It might also be under the Department of Health, but either way the information should be readily accessible. I know in New Jersey, there are lots of mandates about coverage for small groups, but almost all bets are off when it comes to large-group coverage.

To find out what the situation is in your state, visit your state's website.

[Iluvharleys 15]

Kari - Make that call today, you will feel better afterwards. Keep us posted.

Betty

[kari_berry 0]

Hello everyone - well I made the call to my insurance company. I asked if they cover Adjustable Gastric Banding.

The lady kinda hesitated - and then told me that she would have to call me back shortly. So I am awaiting their phone call.

In the mean time - I did make an appointment to go to a seminar with Dr. Zoe Deol. That will be on October 19th.

So I suppose I'll sit here, work, and wait for their phone call!

Thanks again!

~ Kari ~