Hi, trying to get approved in So Cal...

[derbin247 0]

Hi my name is Kelly and I am 26 years old. I live in Simi Valley, CA and I have been trying to get approved for the Lap Band for almost a year. I have been denied three times with my HMO so I just switched at open enrollment to a PPO. I am not sure what my next steps should be once Anthem Blue Cross switches me over to PPO.

My doctor said that as soon as I get the PPO to call her and she will write me a prescription. It is that easy with the PPO. I am wondering though because I have heard stories that it is still difficult to find a doctor. Anyone know of any near where I am at that accept Anthem Blue Cross? What should I do next and how much out of pocket is it?:teeth_smile:

[Jewels68 0]

I have a PPO through Aetna. I have to follow a 90 program they have setup. Onve I complete that my surgery si covered at 90% with $880.00 OOP. So That's all I have to pay up-front. Call the PPO in the morning and see if Lapband is a covered benefit. Some/most employers don't cover it yet under their plans.

[derbin247 0]

Hey thanks, I called Blue Cross and they said that they will pay 80% of it and I will pay 20%. They said anything after $3000 they will pay 100%. I really hope that this happens. Thank you.

[Kellster 1]

You will probably have to do some sort of pre-op regimen that your surgeon requires, which may include a supervised dietician program, psych consult, upper GI, etc. PPO is easier in the sense that you don't have to get a referral before you see a specialist like you do with an HMO. But with the PPO you have that higher out-of-pocket deductible. I have Blue Shield HMO right now and have started the process with my PCP even though I'll be switching to Aetna PPO at the new year (not my choice - thanks to my work). It's been a challenge figuring out if Aetna will work with what I'm doing now but I think I will be ok - it's actually finally a good thing that I'm so heavy.

My best advice is call your insurance company, ask them all the questions you have, bug the crap out of them, document it all, and really get the info on what you need to do. Every insurance plan is different.

Good luck!!!

[Jewels68 0]

My PPO has no deductable and it's covered at 90%. However my out of pocket is only $880.00. So that will be about my cost. They will call my insurance a week before surgery to see if I've met any of it. And that will be the amount I need to bring to them the day of surgery. And believe me they want the money up front. They won't wait and see what insurance will pay first. lol

[WannaBSkinnyB 0]

I have BC/BS Anthem and have no out of pocket for surgery. The doctor I am seeing is a preffered provider. The only thing I have had to pay for is a $20 co-pay for the office visits with the surgeon, dietitian, and psych evaluation. That was total for all 3. So Derbin247 look for a preffered provider.