Lapband Surgical Costs in Alabama

[Savedbygrace 11]

Nina - Here is the policy for BCBS of AL. It looks like it's alot alike other than BC requires 6 COMPLETED months before submitting for approval, it also has BMI requirements, as most do. Is BCBS your primary or Aetna. NORMALLY... the secondary follows the primaries guidelines. I would call and ask the insurance company if that is so in WLS.

https://www.bcbsal.org/providers/policies/final/053.pdf

[moonandstarzz 0]

my primary is aetna. who is ur surgeon?

[weightBgone 0]

Ok im having a hard time trying to find blue cross's info, my husband said that bcbs didnt cover the lapband only gastric, here are my aetna requirements

1. Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multidisciplinary surgical preparatory regimen):
   
   1. 
      
   2. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record. This physician-supervised nutrition and exercise program must meet all of the following criteria:
      
   3. Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and
      
   4. Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and
      
   5. Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records;
      

or

[*]Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions:

1. Consultation with a dietician or nutritionist; and
   
2. Reduced-calorie diet program supervised by dietician or nutritionist; and
   
3. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
   
4. Behavior modification program supervised by qualified professional; and
   
5. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.)
   

[*]and

[*]For members who have a history of severe psychiatric disturbance (schizophrenia, borderline personality disorder, suicidal ideation, severe depression) or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications, pre-operative psychological clearance is necessary in order to exclude members who are unable to provide informed consent or who are unable to comply with the pre- and postoperative regimen. Note: The presence of depression due to obesity is not normally considered a contraindication to obesity surgery

Is that the same as bcbs?? Also who is your surgeon? I started going to my pcp in january, I have gone every month for weigh ins, to talk about what im doing, how im doing etc, she has put me on weightloss med once but was only on it for 2 wks before heart dr took me off it, i havent seen a nutrionist yet (not sure if its mandatory or not) my pcp has me on a 1800-2200 cal diet. im afraid that i will end the 6 mths and then get denied. I also work out 3 times sometimes more a week. I have other questions I just cant think of right now lol. I do have messengers in case you would rather communicate via messengers.

BCBSAL policy is to cover gastric/lapband surgery if you meet their criteria. However, you need to check with your group because it could have a EXCLUSION in the policy. Some employers (groups) have BCBSAL put in this exclusion so the surgery would not be covered. BCBSAL has this exclusion on their own employee plan (which is sad). Below is their policy on the procedure. BE SURE TO READ WHERE IT SAYS ---POLICY---.

https://www.bcbsal.org/providers/policies/final/053.pdf

[forever_baby_21108 0]

How much is the cost of the lap band surgery without insurance (self pay)? Which doctor did your surgery?

[juliacleone 1]

I went to Mexico, Dr. Rodriquez did mine, my best friend and her husband! It was 7500.00 plus air fare. That was in 9-07. I can't believe it has been that long. I still have people exclaim about my loss almost every day.