Has any had Health Alliance Insurance and been approve?

[Catach 0]

I have Health Alliance and last year I asked my doctor about the Lap Band and the first words out of her mouth was they don't cover that and you don't weight enough for the other one. Then sent me to an over weight dietician. I have been on Weight Watchers for 2 years and have lost and gain the same weight.

I live in Bloomington Illinois, does any one know a doctor here that supports the Lap band?

Help.

cyndi

[Catach 0]

I found out as of 1/1/2008 Health Alliance now pays for Lap band with a catch

Coverage requires all of the following:

2.1 The presence of morbid obesity, determined at the time of enrollment in the presurgical

telephonic lifestyle management program, and defined as:

1) BMI > 40 or

2) BMI 35 to 40 with high-risk co-morbid conditions such as life-threatening cardiopulmonary

problems (e.g. severe sleep apnea, Pickwickian Syndrome, obesity-related cardiomyopathy),

severe diabetes, or severe joint disease surgically treatable except for the obesity.

3.

Completion of a minimum six-month presurgical telephonic lifestyle management program is

covered by Health Alliance at no charge to the member.

Successful completion requires:

1) Continuous engagement. Members who are not available for two consecutive lifestyle

coaching calls fail this requirement. Members may request a program interruption if significant medical complications do not allow continuous engagement.

2) Documentation by the lifestyle coach of the member’s serious effort at needed lifestyle

changes.

3) Weight loss equal to at least 5% of what the member weighed at the time of enrollment in the program. This is to demonstrate knowledge and compliance with the life long diet, exercise, and behavioral changes necessary for successful maintenance of weight loss post bariatric surgery.

The member agrees to actively participate with a Health Alliance Personal Health Coordinator for management of any identified co-morbid conditions.

Criteria 2.5 to 2.6 must be met at the time of enrollment in the I Can Change program and will be reaffirmed at the time of surgery.

So basically if I get approve to start the "I can change" program I will not get my surgery until next year.

Why do insurance companies and doctors keep punishing us.