Insurance Question

[Lolacat35 0]

I have my consultation for lap band August 2 and I have BCB of GA. they will pay 90% of procedure with medical necessity. I do not have years of documentation to prove that obesity is affecting my health. I do have horrible foot pain, back pain, high cholesterol, and i guess the worst is the depression i feel like i am in a trap fat because i eat and eat because im fat i know it sounds crazy. what kind of documentation was required by ins. for approval ? is it based on info specifically from bariatric surgeon ?

thanks a million !

[StrawberryGrl 0]

My insruance company also covered 90% of my surgery. They required documentation from my surgeon, primary physician, nutritionist, and a phsycologist evaluation. Most of this was something that had to be submitted in letter for as to that yes I indeed needed the surgery. I also had an option of writing a letter myself telling the insurance company how haveing the surgery would benefit me. You muight want to ask your surgeons office about this. I chose not to write the letter and let the documentation speak for itself, but it may be something you want to do. Good luck!!!

[ChihuahuaMomma 0]

strawberry Grl----usually they say: You have to have a medical condition (OR) be over 100lbs overwieght or over 40bmi. I called my insurance place and the lady told me that same thing...that I couldn't just get the surgery, that I needed to have a medical condition. But I hung up and called right back and got a guy who told me that above statement I wrote. So on things this important, I'll call back 2-3 times and make sure they all give me the same answer. Then I KNOW it's right.

As for documentation, ask your doctor if they can document that you might be PRE diabetic or something to do with bloodsugar. Just a thought.

[Lorien 0]

I hope you have better luck than I did with this. I'm being treated for back pain in addition to having a serious weight problem. My insurance company said that they consider the Lap-Band an "elective" surgery, so I'm having to be treated for obesity by my Doctor for one year before I'll qualify to have the surgery!! Even with a letter from my doctor, they will not consider the surgery anything other than elective. (Then I'll have to pay for part of it on top of that).

I'll also have to have the standard documentation from my surgeon, a nutritionist, and a phsycologist evaluation, too.

They did allow my doctor to amend some of my visits for pain management, because we did also talk about my weight problem. That allowed me to move my wait up about 4 months in the process.

It's frustrating because I can't walk more than a few steps unassisted, and still they wont grant me the surgery. After tomorrow, I'll have 8 visits completed so I hope to get it before the end of the year!

Good Luck!

[ChihuahuaMomma 0]

Gosh that's horrible! I am sorry they are being such a pain. But you are going to get it-eventually-and when you do, you'll be so glad you did...of course I haven't got mine yet either so I am just going on what everyone's said. I've never heard anything negitive about it and there's a TON of people I know that have got the surgery. Only one person I know of didn't lose much wieght but that was because she didn't change her eating habits...she still ate bad food is what I think happened. I've heard it said that since you only have a little room in your belly, make it count...eat good food - I think that's why it didn't work for her very well...ANYWAYS, back on the insurance thing. I guess I can REALLY count myself blessed to have a great insurance! Atnea POS-Managed Choice pays 100% with no ded. (I am not bragging but spreading the news in case someone's looking for a way to get thier surgery paid for and they can get Atnea.)

I just hate that you're having so many health difficulties. I know exactly what you mean though. I am only 29 and I feel like my body is falling apart!!! I can't even begin to tell you everything wrong with me. I know it's from abusing my body with food. That's why I sooo much look forward to getting surgery because I don't want to feel powerless over that anymore!