Did your insurance cover your lap-band?

[cyndilou29 0]

Well, interestingly, my plan excluded it from coverage so I decided to go the self-pay route. It was going to be about $16,000 for the surgery and pre-op stuff. However, the hospital still submits all bills and I'm shocked at what they covered. They didn't cover the anesthesia or the band but did cover the surgeon (go figure. Apparently it's okay to have surgery but no anesthesia for me!). They covered the lab work and pre-op visits (except one visit to the nutritionist - $120). Still waiting on whether they cover the hospital room or not but so far they've paid about $6000. Not bad!

[FarmerE 0]

My company has a weight loss surgery exclusion with United Healthcare. I'm sure I could have fought it but since I'm one of the lucky ones that doesn't have the comorbities YET, I decided to go the self-pay route. I didn't have much to stand on other than I am severly overweight.

[WASaBubbleButt 41]

My insurance covers it but it was a six month medically supervised diet, etc. I didn't want to wait. I'm not all that far from goal and had I used my insurance I'd just now be able to get surgery scheduled vs. almost being at goal. I don't regret paying the $7800 at all.

[Manatee 4]

Y'all are going to hate me

My insurance covered it (United Health Care). I thought there was an exclusion, but I asked HR and they said that the insurance covered bariatric surgery through the end of 2007 and it was going to be dropped in 2008.

I routinely go to the doc every 6 months or so for a checkup, and so I already had the 5 years of weight history and the co-morbidities documented. (For those who are curious -- sleep apnea, high cholesterol numbers and something called "metabolic syndrome".)

Gave my insurance info to the specialist, they cranked it through, and I quite literally had the surgery about a month after asking HR about coverage.

Sometimes, things just go right

[faithmd 14]

Manatee, that's AWESOME!

[Lucy 0]

My insurance is Aetna through my husband's employer and they did not include bariatric surgery of any kind in the policy. I thought about fighting and appealing, but I have a lower starting BMI and I didn't want to wait 6 months to a year for the slim chance that it would be covered. I also figured that I would be spending so much money on psych evaluations, tests, etc. and there was no guarantee it was going to be worthwhile. I took out a loan and paid for it myself, $15,000.

[Qvrfullmidwife 0]

Yes, no and no.

YES, the coverage that we have now (BCBS Activecare w/TRS) covers WLS incl papband. But they require 5 years at a BMI of 40. NO, I do not have that. Also, they require a 6 month diet and if all goes absolutely perfectly when I finish the 6 mo diet I will be right at the time when we will be switching to the insurance with my husband's new employer. And NO, the new insurance does not cover it, not for me and not for anyone, it is categorically excluded.

So we had a choice to make...try like crazy to jump through BCBS hoops, hoping that they might approve me, but if they dont then we are 6 months further down the road with no hope in sight, or go straight to selfpay.

So we have applied for home equity loans and will selfpay ASAP.

[Qvrfullmidwife 0]

Well, interestingly, my plan excluded it from coverage so I decided to go the self-pay route. It was going to be about $16,000 for the surgery and pre-op stuff. However, the hospital still submits all bills and I'm shocked at what they covered. They didn't cover the anesthesia or the band but did cover the surgeon (go figure. Apparently it's okay to have surgery but no anesthesia for me!). They covered the lab work and pre-op visits (except one visit to the nutritionist - $120). Still waiting on whether they cover the hospital room or not but so far they've paid about $6000. Not bad!

This is a good point, I think that I will have to keep this in mind...so, did you pay upfront and then they submitted and you were reimbursed, or...???

[NanaRenan 0]

My advice to anyone who has to do the supervised diet, do not miss one single monthy visit, not one! My insurance company has a compliance requirement and if you aren't attending (meaning going to the MD) monthly, then you start from square one.

My policy with Aetna required a '90-day' program as part of the criteria for submission. The surgeons's office allowed me to do my monthly weigh-ins at my GP's. But they sent it in with only 3 dates" March 19, April 20th and May 2nd....the girl assured me that it would be fine since it was three calendar months.

It wasn't. Aetna kicked it back on appeal.

Good thing I also went in on May 22nd!! So, June 19th, they sent in an amended appeal with the updated facts. I'm like a cat on a hot tin roof!!!

The NOT KNOWING is excrutiating!

But in all honesty, getting denied relieved some of the pressure!!! I'd been dreading that for so long that it felt good to get it overwith!

[uniqueone 0]

My insurance UHC paid everything but $2000.00. However, for years it didn't cover any bariatric surgery and I thought it was still that way. I was more than ready to take out a loan and be a self-pay, thinking I would have to apply for one for about $10,000. There was never any doubt in my mind that I would do this. I was ready and nothing was going to stop me...not even being in debt!!!!

[uniqueone 0]

..and had I known about Mexico and their rates, I would have gone there if I had been a self-pay provided I could have found a local fill doctor since Mexico is a few hundred miles from me.

[mermaidpuppy 0]

I just got my letter of approval from BCBS NC today!!! I went to my first seminar mid March, and finally got finished with my checklist! I didn't have to have the 6 month weightloss program. The only thing I had trouble with is 5 years of recorded weights. They will actually accept 4 out of 5. I had avoided Dr's offices so this was hard. I had to scrape together records and only ended up with 3 years worth, so they accepted a "fat" dated pictures of me to prove i was a chunky girl that year as well! It took forever it seems to go through the checklist my surgeon's office/insurance needed..... More tests that I have ever taken in my life! The Upper GI was a personal favorite. But it was submitted on Tuesday and I called BCBS Thursday and they said it had been APPROVED!!!! I got my official letter today in the mail. The lady at BCBS even said "enjoy your new life"! -Which was kinda sweet. I hope to schedule the last week in August. I know this is just the beginning, but getting approval was much easier than I though it woud be. I assumed it would take weeks....... and maybe even a few appeals. I work with an oral surgeon and jaw surgerys are denied ALLLL the time. So I didn't have much "hope" for it being quick and easy. I stand corrected! Can you tell im giddy? I can't wait till they poke holes in me!!! Bring it on.

[mistyone 0]

My insurance company excluded any type of weight loss surgery. I went to Mexico so it all worked out fine.