Sad News

[SoapOperaStar86 0]

I went for my consultation a week ago and the Dr told me that my insurance pays for the lap band procedure but only if there is a medical reason why I can't have the Gastric Bypass ... and there isn't a medical reason why I can't have the bypass

I was very distraught after I found this out because I felt like this surgery was a perfect fit for me

Now i'm left with the decision to have the gastric bypass surgery or not...

Does anyone know of any websites or message boards for gastric that is similar to this one? I loved this board and was able to get some much info and support from it

*And if you know of any websites/message boards geared torwards younger people that would be great as well

Thanks <3

[kacee 3]

Frankly, I find that completely insane. Unfortunately many insurance companies are not recognizing the lapband yet. They will qualify you for a substantially more invasive, expensive procedure with potentially more complications.... Is this your primary care physician or your potential surgeon? Who is your insurance provider? On the other hand, at least your insurance pays for SOMETHING. A co-worker of mine is a bypass success story...three years out and 160 pounds down.

[TerriDoodle 6]

I would appeal that decision...and appeal again....and again.....all the way to the very end. Find out what you need to appeal and do it. I'm sure your doctor will help.

[uniqueone 0]

I agree with Jack. If you "shop" around you will be able to find a doctor who is informed about the two procedures. The potential risks alone should be enough to justify the band over the bypass if the doc knows what he's doing. My surgery was done through a bariatric center that performs both procedures. The doctors there would have definitely explained to the insurance company why I needed the lap-band over the bypass. Good Luck!! Like the other poster said, you are indeed lucky your insurance company will pay. Now..hunt around and get what you want. It might take some time, but, you'll do it!!!!!!!!!!!! Hang in there!!!!

[TerriBarri 0]

I totally believed this was the answer for me and when they told me my insurance would not pay at all I was so sad. I decided to go to the seminar anyway and found out that if I had a hiatal hernia my insurance would pay for half. WOW! I did in fact have a hiatal hernia, opened a cc just for the balance ($7000) and got the surgery. I was determined to find away. God had answered my prayers.............you too will find a way. Good Luck

[faithmd 14]

SoapOpera: try Obesity Law and Advocacy Center It is a website for a law firm that helps people deal with their insurance companies when they have issues like this one.

[pvchickie 0]

You had asked about a chatroom that talked about the gastric bypass...well I have been on the Obesityhelp.com site and there is a chatroon and it seems it there are tons of gasatric bypass folks...hope this helps...and i hope you end up with what you are wanting.

GBYalways

tara

[ragdollx19 1]

Have you called your insurance company yourself to see if they cover the lap band without a reason for not having the bypass. I would call them and give them the cpt code for the lap band and ask myself! I am not saying it is the case but there are doctors out there who push for the bypass procedure.

[SoapOperaStar86 0]

thank you all so much for your help and information!

Hopefully i'll be in contact with my insurance soon to see if there is anything i can do

what i'm worried about is that i'm only covered on my parents insurance till May (thats when I graduate college) so i guess we'll see what happens

thanks again :eek:

[lag1949 0]

Need you find out if anyone has experienced this problem with their Insurance Company.

I called a Surgeon today and did a short interview they took my insurance info but they told me I would probably have to be on a Diet with my Family Doctor for at least 6 months before the Insurance would let me have the lap banding done.

I was really shocked, I didn't realize this would be such a long process.:eek:

[musicalmomma 1]

I've read this post a few times and just can't get past the feeling that the surgeon is full of sh*t.

Have you contacted your insurance company? If not, call them and tell them to send you the portion of your policy that contains weight loss (or bariatric) surgery criteria.

It just seems weird to me, for a surgeon, to be so well versed in your particular insurance. My surgeon doesn't know one insurance from another, and I've never had a doc that knew anything about coverage...they all left that up to their office staff. Unfortunately, there are surgeons that are only after the big bucks and RNY is twice the money (or more) than LB. Also, many surgeons aren't too comfortable with LB yet.

So, after you get the criteria from your insurance, in black and white. Take that with you to other consultations/seminars. Remember, your relationship with your surgeon will be for years to come and you want to be comfortable with him/her.

Best of luck to you :eek: