So Much for Pacificare!

[serenity55 15]

I found out today that my doctor had submitted a request for gastric bypass, not the lap band. I don’t know whether to blame her or the woman who does the authorizations. I must have said lap band a million times when I was in the office, so I can’t believe my doctor didn’t know that was what I wanted.

I spoke with someone representing my service provider and was told that Pacificare HMO will not pay for the lap band because it is “a foreign body.” This woman, who was very nice, suggested I talk to someone in the Human Resources department at work, which I did. I can’t change to a PPO until next year, because open enrollment is over, and even if I did, the deductible is not something I can deal with. The guy in HR did give me the name of a woman who might help me “maneuver” through the system. If this doesn’t work, I may have to look at self pay, something I’m not sure I can afford.

[Futr littl Debi 0]

I have PacifiCare HMO and they are covering Lapband. PacifiCare doesn't have an exclusion for it, but the coverage that your employer purchased might. I would call customer service and find out for sure. Their number is on your ID card. The last time I checked, the only weight loss surgeries that PacifiCare covers (if the employer purchases weight loss surgery coverage) is gastric bypass and Lapband. Perhaps the person you talked to got confused thinking it was a different procedure.

Anyway, check your policy and call customer service at PacifiCare instead of your IPA (the group that your doctor belongs too). It is the IPA's job to administer the PacifiCare coverage. They have to follow the PacifiCare rules on it.

Good luck.

[serenity55 15]

I did speak with someone from Pacificare today who explained to me exactly what you were saying. She’s going to check to see if the plan, or whatever it is that my employer has, covers lap band. She explained to me that Pacificare is the broker, and the physicians’ group actually pays for the procedure. I have a sinking feeling that it’s not covered in my work place. But this woman, who was very nice, also told me that the person at the IPA shouldn’t have told me what she did about lap band being a “foreign body.” I also called my doctor’s office and left a message asking why they submitted a request for gastric bypass instead of lap band.

Thank you, Debi, for your support.