what insurance co's pay for the band?

[Wheetsin 714]

Here's what I did. I started at my current employer in June. When it came time to pick my carrier, I "circled" those that I knew had covered some type of WLS procedure before. Then I asked to see their SPDs, and read each one to see who had WLS exclusions and who did not. This brought me down to 4 choices. Of these 4, I went with the one that had covered the most WLS procedures in my geographic area. It just so happened to be the same carrier I had at my previous company, and I love 'em.

Once I knew which carrier I was going to have, I talked with my employer's HR area to ask if they had any policy exclusions, as mentioned above. They told me that they offered the po;icy at face-value, ala did not deny anything the policy included.

After I was approved (apparently w/ no requirements other than high BMI) I called my HR area again, and told them I had received a letter of pre-approval, but the letter said that my coverage "may or may not" cover the WLS. I asked them if my coverage would or not. Their reply was that the letter must have been a form letter, because they do not dis-allow anything that the SPD allows for.

BTW, here's word on the street, so to speak. I've heard this both from a good friend who is a doctor, and from my personal doctor. Insurance companies got a lot tigheter about WLS this year, and are expected to get even tighter before the year is over. Why? They're realizing that it does not make financial sense for them to cover the cost of the procedure. Yes, it is cheaper than medications & treatments for comorbs in the long run, but "in the long run" is the key phrase, and the average subscriber does not stay with the same company for "the long run". Too many people changing jobs, changing providers, etc.

I didn't have any problems with my coverage. In fact, I didn't have to submit a diet history or have one single test outside of my physical. I don't have significant comorbs. My blood levels are in check. Blood pressure is spot on. No diabetes. No hypertension, etc. My company still pre-approved me within a week.

BTW - do check with your employer. My employer is within the top 35 of the Fortune 500, employees who knows how many people, and did not exclude anything from the carrier's policy.

Doh, I forgot! I have UHC EPO.

[bronco 0]

As this is open season for Federal Employees, I have been considering which insurance to select in large part based on their willingness to do LapBand.

I currently have Mail Handlers and spoke with a nurse who sent me their checklist - they do cover this procedure. The difficulty she indicated is "documentating that the patient has failed to loose weight (10% from baseline) or has regained weight after participating in a 3 month physician supervised multi-discipinary program within the last 6 months" .

GEHA also covers this procedure but requires documenting failure to lower BMI after a 6 month medically supervised program of weight loss.

The point is that they (FEHB providors) are now covering this procedure but it will require navigating their process which can be daunting.

[mvazquez 0]

does anyone have CDPHP ??? i live in NY and i have cdphp but im not sure if it covers for lap band surgery if anyone knows please reply