Will insurance pay for fills and not WLS?

[work_in_progress 0]

Wondering if anyone has had luck getting their insurance to pay for fills when they don't cover WLS? I saw one post that said they could charge for an ultrasound, injection and office visit and the insurance co. would pay. I'm having surgery with Dr. Kirschenbaum on May 14th and would like to be able to get my fills close to home (and payed would be nice).

[HeatherO 7]

I am interested in the answer to this as well since I am a self-pay patient.

[PATCHELTON 0]

My insurance (Carefirst Blue Choice) paid for my surgery (including a night in the hospital) but does not pay for fills or anything related to weight loss or weight control. Go figure! I haven't heard of any not paying for surgery but paying for fills. Your description of how the doctors office billed insurance sounds like the charges have been reworded to acceptable charges, and the relationship to weight loss surgery carefully omitted. Good for the patient; maybe not so if the insurance company finds out.

[work_in_progress 0]

That's the first I've heard of an insurance paying for surgery and not fills. I agree with you about the possibility of the doctor being liable if they don't code for weight loss. It would surprise me if they actually do that. Way to go on reaching your goal so quickly! I'm right where you were last year and my goal is also 150. You are my inspiration :wink: Any words of advice would be greatly appreciated.

[MacMadame 81]

I think it would depend on how it was coded. I was looking at one place and they said they code fills as an office visit so they are always covered. But I've definitely heard of insurance companies paying for band surgery and not fills way more often than that.

[PATCHELTON 0]

That's the first I've heard of an insurance paying for surgery and not fills. I agree with you about the possibility of the doctor being liable if they don't code for weight loss. It would surprise me if they actually do that. Way to go on reaching your goal so quickly! I'm right where you were last year and my goal is also 150. You are my inspiration Any words of advice would be greatly appreciated.

My best advice is take full advantage of the resources offered by your bariatric center. Support groups are wonderful; I started going to them the summer before my surgery. You can learn a lot. I have a problem eating bread so I eat very little. Fat free croutons on my salad go down well. They disintegrate and bread gets chewy. I am a reformed pizzaholic (my idea of working out was to go to Curves and pick up a 12-15 inch pizza on the way home and eat the entire thing--a serious pizzaholic). Rather than deal with all that dough, I devised a crustless pizza that gives me all the toppings with none of the crust (take a microwavable dish-meal portion size-cover bottom with 1/3 to 1/2 jar Ragu Homemade Style Pizza Sauce, cover that with Hormel Turkey Pepperoni, then I top with peppers and onions-I use Birdseye Pepper Stir Fry-top with Kraft fat free mozarella or cheddar-nuke on high for 2 minutes). I also do variations on chicken caesar salad. I use those green bags you see on TV, buy Romaine in heads, break some up, cut up a hard boiled egg, add a grilled chicken breast or turkey cut up, sprinkle parmesan cheese and I use light caesar dressing with fat free croutons. I don't like to cook much so I have salad a lot. I make chili with ground turkey, reduced salt chili seasoning, a can of kidney or pinto Beans undrained, and a can of chopped green chilis--brown the meat, then add the other stuff and simmer-when hot throw some Kraft fat free shredded cheese on top. A pot of chili makes 5 or 6 meals for me now. Before about 2. When I eat out I frequently stick to an appetizer and salad, just to be safe. But I tried some mozzarella sticks recently and they got stuck so I was in the restroom sliming for 20 minutes. I just told my friends the cheese didn't agree with me. I also still drink a Protein Shake every workday and sometimes weekends too. I carry Kashi TLC bars in my purse, in case I can't eat on time and I am starving. They have less sugar than most and some Protein so unless you are low carbing they are not bad. When shoping I read labels like a maniac. I try to find the lowest fat and sugar first, then lowest salt and then carbs, and the most protein I can find. For Snacks I use Kays Naturals Protein chips. They sell Cereal, pretzels, a variety of snacks, all high protein, gluten free, low sugar, not too bad on carbs. They come in 1-1.5 oz bags. The web sits is kaysnaturals.com. Their shopping cart has been down recently, but keep trying. They keep me out of potato chips and cheese curls.

I also have made a serious commitment to exercise. Nothing fancy, mostly walking. I walk in a park near home, carrying peanuts to feed the squirrels. The park has a 2 mile nature trail. I try to do at least twice, and if time, weather and such permits, I will do 3 and sometimes 4 times around. The squirrels are ecstatic when I do that. Until daylight savings comes back, during the week it is too dark so I do Curves (minus the post workout pizza) and Water aerobics. The absolute most I take off is 2 days, but I try for only one day off from exercise. When the daylight comes back I will likely walk daily as I pass the turn for the park to go home after work. Curves is also in the center where I turn off for the park, and the aquatic place is also on the way home, a factor of importance if the gas prices go back to $4.00 a gallon. Find something you enjoy doing and it will be much easier to stick to it. If it is a chore you will end up quitting.

I was never much of a walker before, but I started before surgery, and I could see a difference in how my clothes fit even before I was banded. I was a women's 22 (now misses 12) and a 2X in work clothes (now medium tops and small pants--I wear scrubs).

Not every day is perfect, but if I eat something I shouldn't, next day I am back on track. I try not to beat myself up about it. I also weigh myself daily--can't stand the suspense of that once a week stuff. I can also adjust if I see my weight creeping up. Once a week would drive me nuts.

Now if I could just find a really good plastic surgeon who is hot to do some pro bono work . . .:yikes:

Edited January 16, 2009 by PATCHELTON

[texasweb 0]

My best advice is take full advantage of the resources offered by your bariatric center. Support groups are wonderful; I started going to them the summer before my surgery. You can learn a lot. I have a problem eating bread so I eat very little. Fat free croutons on my salad go down well. They disintegrate and bread gets chewy. I am a reformed pizzaholic (my idea of working out was to go to Curves and pick up a 12-15 inch pizza on the way home and eat the entire thing--a serious pizzaholic). Rather than deal with all that dough, I devised a crustless pizza that gives me all the toppings with none of the crust (take a microwavable dish-meal portion size-cover bottom with 1/3 to 1/2 jar Ragu Homemade Style Pizza Sauce, cover that with Hormel Turkey Pepperoni, then I top with peppers and onions-I use Birdseye Pepper Stir Fry-top with Kraft fat free mozarella or cheddar-nuke on high for 2 minutes). I also do variations on chicken caesar salad. I use those green bags you see on TV, buy Romaine in heads, break some up, cut up a hard boiled egg, add a grilled chicken breast or turkey cut up, sprinkle parmesan cheese and I use light caesar dressing with fat free croutons. I don't like to cook much so I have salad a lot. I make chili with ground turkey, reduced salt chili seasoning, a can of kidney or pinto Beans undrained, and a can of chopped green chilis--brown the meat, then add the other stuff and simmer-when hot throw some Kraft fat free shredded cheese on top. A pot of chili makes 5 or 6 meals for me now. Before about 2. When I eat out I frequently stick to an appetizer and salad, just to be safe. But I tried some mozzarella sticks recently and they got stuck so I was in the restroom sliming for 20 minutes. I just told my friends the cheese didn't agree with me. I also still drink a Protein Shake every workday and sometimes weekends too. I carry Kashi TLC bars in my purse, in case I can't eat on time and I am starving. They have less sugar than most and some Protein so unless you are low carbing they are not bad. When shoping I read labels like a maniac. I try to find the lowest fat and sugar first, then lowest salt and then carbs, and the most protein I can find. For Snacks I use Kays Naturals Protein chips. They sell Cereal, pretzels, a variety of snacks, all high protein, gluten free, low sugar, not too bad on carbs. They come in 1-1.5 oz bags. The web sits is kaysnaturals.com. Their shopping cart has been down recently, but keep trying. They keep me out of potato chips and cheese curls.

I also have made a serious commitment to exercise. Nothing fancy, mostly walking. I walk in a park near home, carrying peanuts to feed the squirrels. The park has a 2 mile nature trail. I try to do at least twice, and if time, weather and such permits, I will do 3 and sometimes 4 times around. The squirrels are ecstatic when I do that. Until daylight savings comes back, during the week it is too dark so I do Curves (minus the post workout pizza) and Water aerobics. The absolute most I take off is 2 days, but I try for only one day off from exercise. When the daylight comes back I will likely walk daily as I pass the turn for the park to go home after work. Curves is also in the center where I turn off for the park, and the aquatic place is also on the way home, a factor of importance if the gas prices go back to $4.00 a gallon. Find something you enjoy doing and it will be much easier to stick to it. If it is a chore you will end up quitting.

I was never much of a walker before, but I started before surgery, and I could see a difference in how my clothes fit even before I was banded. I was a women's 22 (now misses 12) and a 2X in work clothes (now medium tops and small pants--I wear scrubs).

Not every day is perfect, but if I eat something I shouldn't, next day I am back on track. I try not to beat myself up about it. I also weigh myself daily--can't stand the suspense of that once a week stuff. I can also adjust if I see my weight creeping up. Once a week would drive me nuts.

Now if I could just find a really good plastic surgeon who is hot to do some pro bono work . . .:yikes:

How does your lengthly response deal with the question ..

Will insurance pay for fills when they don't pay for WLS ..

Did you mispost?

[texasweb 0]

Wondering if anyone has had luck getting their insurance to pay for fills when they don't cover WLS? I saw one post that said they could charge for an ultrasound, injection and office visit and the insurance co. would pay. I'm having surgery with Dr. Kirschenbaum on May 14th and would like to be able to get my fills close to home (and payed would be nice).

I have Anthem Blue Cross Blue Shield of CA.

They will not.

Here is the clause;

HCPCS

S2083

Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Note: medical necessity criteria for adjustments are based on whether or not the original surgery was considered medically necessary

[luluc 6]

my insurance at the time of surgery (BCBS) did not cover my surgery - due to low bmi, not because they didn't cover WLS.

i now have united health care and they pay 100% of aftercare for my band; including fills/unfills. i'm not sure about the billing; all i know is i just have my co-pay ($10) fee.