Lap Band Excluded From Policy

[BabyGirl127 0]

Hi All,

I'm genuinely heartbroken this evening. I just got the call from Dr. Enochs' office that I am NOT covered under Aetna for Lap Band surgery.

Apparently, my policy excludes weight loss surgery all together.

I really feel defeated here...I don't have $23K to drop for the surgery, but I genuinely need it. My BMI is at 47.6. I don't have any other health issue, but under Aetna a BMI of 40 and higher was all I needed.

I've submitted a letter to my HR dept. I'm not sure if that will help, but I don't think it could hurt. I know open enrollment is coming up soon. I inquired about whether they were looking to move to another carrier, and if so will they be excluding weight loss surgery again.

I'm open to advice and suggestions.

All My Best,

BabyGirl 127:frown:

[Babe 0]

i am so sorry this is happened. i have to self pay myself, and I'm probably going to get a loan to do it. have you considered Mexico? I'm hearing a lot of great things on the boards here about Dr. Ortiz at the Obesity Control Center an it's only 8 or 9K.

[ckelly37 1]

I had that 2..i hap aetna thro my employer and bariatric surgery was also excluded from my policy...so i switched insurance companies i researched different companies that accept WLS and got personal choice...i got my new insurance 7/1 and got approved 7/8 had surgery 9/8 only had to pay $1300 out of pocket..good luck

[BabyGirl127 0]

Hi Babe,

I'm beginning to research Surgeons in Mexico now. I want to see if my company moves to a new carrier and if they will exclude under the new plan. If I hit another brickwall, then I will go for plan B - Mexico.

I'm really nervous about having my surgery in Mexico. I wonder about how I will manage getting my fills? If something goes wrong or if I run into complications, will Aetna or my new insurance company pay?

Too much to handle now. I will cancel my Psychologist visit scheduled for 11/6. That wasn't covered & I would've had to pay out of pocket.

I'm truly going to need to pull on a higher force for strength to get through this rough period. Normally I would eat to not have to feel this pain and disappointment. But I refuse to slide back into that abyss...I want NEW LIFE!

May be this is a test to see if I can shake my old habits of using food to deal with adversity. I'm really sad. I feel like my hope is dying. I probably just need a really good cry, and I pick myself up in the morning.

Have a good evening!

...This too shall pass:frown:

[BabyGirl127 0]

Hi CKelly37,

Your employer offered multiple insurance carriers?

My company usually picks 1 carrier but offers two plans HMO & PPO.

I know I have to stay positive. Back in 2007 I remember calling Aetna member services and they told me about the exclusion, but a friend who had Gastric Bypass suggested I pursue via a surgeon.

I don't think she fully understood my issue. There is a difference from being denied and NOT being covered.

Thanks for your reply.

[Jewels68 0]

I too have Aetna. My husbands first employer of 12 years did not allow the Lap Band. He now works for Comcast ad it is a covered benefit. We had 5 insurance policy's to pick from and all but one allowed the surgery.

My mother in law has Group Health. Not sure if that's local to WA state or not. They wouldn't cover hers either. She went to Mexico and had Dr. Ortiz. She loved him. For her and my father in law to go with air fair, hotel & surgery it was under $8000.00.

She now gets her fills at a local provider.

Keep your chin up.

I'm having my surgery next month after years of wanting it and waiting to get the money. Now I can with new insurance.

[Jewels68 0]

I too have Aetna. My husbands first employer of 12 years did not allow the Lap Band. He now works for Comcast ad it is a covered benefit. We had 5 insurance policy's to pick from and all but one allowed the surgery.

My mother in law has Group Health. Not sure if that's local to WA state or not. They wouldn't cover hers either. She went to Mexico and had Dr. Ortiz. She loved him. For her and my father in law to go with air fair, hotel & surgery it was under $8000.00.

She now gets her fills at a local provider.

Keep your chin up.

I'm having my surgery next month after years of wanting it and waiting to get the money. Now I can with new insurance.

[kgloverii 0]

Your employer chose to not cover WLS. They can add a rider so that the policy would not exclude WLS. When you are considering your options during open enrollment, call the insurance company and ask them specifically about your company's policies to see if WLS is covered. GL!

[MacMadame 81]

I don't have $23K to drop for the surgery

There are places in the US who don't charge that much. LapSF charges around 14,000 and we're in one of the highest CoL areas in the country. I bet if you shopped around you could find someone local who is nearer to that price.

[gentylwind 1]

Yeah, I have only seen one place here in Dallas charge over 15K for lap band. The place I am using (and several others now I have found) cost $9990, all inclusive (except for the psyche evaluation and the pre-op Optifast). This includes the first six fills.

Keep your chin up. There are more affordable options and you could look into financing as well.

[BellaPerdente 0]

Check out Dr. Kirshenbaum in Denver, CO. He has a HUGE following. I had mine done on 7/18/08. He is wonderful. Only $9950 for everything. Nothing but good things to say about him and his staff. Considering Dr. Kirshenbaum