what insurance co's pay for the band?

[lovecats85 2]

My hopefully-soon-to-be band doctor suggested I switch insurance companies since I have blue cross blue shield and they don't cover it. can you guys tell me what insurance you have and how easy/hard it was to get it covered and what the pre-reqs were. thanks

[paula 4]

Hi Lovecats,

Thats really a tough question to answer. There are tons of insurance companies that pay for AGB (Adjustable Gastric Banding - lapband). I recommend that you get a copy of the different insurance companies that your work carries, and start from there. You can get phone numbers for each one and simply call and ask them IF they pay for this surgery! Thats where I would start.

The requirements vary from one company to another. Some ask for documented weightloss attempts from a physician for at least 6 months prior to WLS (weight loss surgery)... some Ins. companies require you to have a physic. evaluation, some require a consultation with a dietian - some want you to get both. Each one has their own rules.

Once you find the "right" Insurance company, they should be able to answer that question.

Good luck.

(I had Mail Handlers Benefit Plan Insurance company)

[brneyezz 0]

I have BC/BS of Illinois and they cover it. I also work for Great West Healthcare and we approve them all the time.

[Alexandra 55]

Lovecats, I'm guessing you don't live in NJ. Every state is different, in fact lots of Blue Cross companies DO cover banding.

You'll have to give more information about where you live before anyone can give you helpful advice. And even then, a lot will depend on the particular plan you have; one carrier can have many, many different plans.

[seppi 0]

I have bluecross/blueshield of NJ and they cover everything

[TraumaNurse 1]

I also have BC/BS (of Mass) and they covered my surgery 100%...

[gordonfamily3 0]

I have United Healthcare and I was approved...in NC

[HotLikeHer 0]

I am still waiting for my approval, but I have Empire BCBS and live in Fl, but it is a covered procedure on my policy.

[Madeline's mom 0]

This link was very informative about several different kinds of insurance and what the requirements were for each. Hope it helps! http://www.stvincents.org/healthservices/bariatrics/informationinsurance.cfm

[Blonde.Moment 0]

I have BCBS of LA I wonder if they will pay for my fills since I self paid my surgery, does anyone know?

["Nita 0]

It isn't only the different agencies but what specific plan your company has. If the company can add clauses to the insurance. For instance, I have United Healthcare which covers most people's band 100% but the company my husband works for (which is self-insured through UHC) has a clause that they only allow 50% coverage for any obisity related surgury and there is a clause that it has to be at an outpatient facility and yada yada yada.

So it probably wouldn't be of much help to know what agency covered other's bands because it will depend on the actual policy.

[soonergirl 0]

I posted this a while back, trying to offer some clarification on the insurance issue. The important thing to remember is that the POLICY dictates whether it is covered or not, NOT the carrier. The carrier may help make a determination of medical neccessity and whether or not the band is an approved method or not, but the POLICY HOLDER (IE your company) detremines what is covered in the policy. Private or individual policies gernerally will not cover this procedure.

Clarification on Insurance

<HR style="COLOR: #d1d1e1" SIZE=1><!-- / icon and title --><!-- message -->Just to offer some clarification on the entire issue of insurance in general on this issue - ( I happen to work for a carrier)

1) If you work for a large employer - chances are your group is what is called self-funded, this means that your company is actually paying the claims, not the insurance carrier. The insurance carrier is just administering the claim. The employer will actually set the rules around what is and what is not covered. The company will also approve the process that the carrier uses to determine elligiblity for this type of procedure. Only in some states are their state mandated benefits. Thus, you can have two people with the exact same situation, both with the same insurance carrier's name on their card with very different situations. (I know for a fact that Union Pacific is self-funded)

2) BCBS is mentioned a number of times - All BCBS companies are not the same, they all carry the BCBS logo, which only means that they are a part of BCBS Association. BCBS of Illinios owns the BCBS in TX and NM. Empire is a seperate BCBS of its own. Wellpoint owns BCBS in Colorado, California, MO, and 10 other states (previously known also as Anthem BCBS).

3) So- if the company that you work for, or the fully-insured policy that you have approves the surgery, then it will go to the medical review. They will often deny the claim in the first go around, but it would definetely be worth appealing in all situations. Most of the time the first refusal is automatic and NOT a decision made by an individual, but a computer that is looking at a number of different factors. Once appealed, most companies send it to a medical review board where individuals actually evaluate and make a decision about the claim.

All companies and policies are different, take the time to put some research into it!

Hope this helps to understand the insurance side a little better.

[mousecrazy 2]

Hi! I found this info on a Dallas area bariatric surgery website: http://www.bscdallas.com/insurance.html

Perhaps it will help, but like Soonergirl says, it all depends on the policy...

Good luck! Cindy

[lovecats85 2]

thanks SO much for the info - you guys are the best!

[kellcap 0]

I have BC/BS of Illinois and they cover it. I also work for Great West Healthcare and we approve them all the time.

how much does great west cover? will i just have to meet my deductable?