Kaiser Permanente...

Crystalstar11 · August 25, 2005

Hello Everyone,

Before signing on as a member of Kaiser I called their member services to find out more about the benefits and if the Lap Band surgery was covered. The benefits were explained to me and I was told that yes the Lap Band was covered. I was happy about this information and decided to sign up with Kaiser.Well after almost three months of being told that Kaiser would cover the Lap Band surgery and after I started the weight loss surgery process that Kaiser has. Now I have been told that they don't cover it. Not until I started asking for something in write did things change. I now need to know if anyone has gone through this with Kaiser and any information that you can share with me about Kaiser would help support me in my efforts to further pursue this.

Thanks for your help, Karen

kat72 · August 26, 2005

Crystalstar, I was just curious...My insurance co. did the same thing-about a month ago I was told that RNY as well as the lap band were covered. Well, I called back a couple of days ago (just to make sure), and was told that only the RNY and the vertical band were covered. My question to you is: were the benefits just not updated at Kaiser? Because as far as I know vertical banding is no longer performed in the US? Also, were you denied coverage and had to do an appeal? Or did you just call the insurance group and ask them to send you something in writing as to ahy the lap band was not covered? I wish you the best in pursuing your goal of having lap band ssurgery.

i2candoit · August 27, 2005

I have Tricare and was told they do the Lapband when I called. I was also told countless of times from people, nurses, etc. that the Lapband was covered. But it is not.

I think they hear the Lap and ignore the word band, and automatically think you are talking about laparoscopic.

Anyways, thats my take on it. I'm 5 months into my denial and appeal and when I call they still are confused.

I think we would just be better off using cpt codes.

Good luck,

Kelly

rene2005 · August 27, 2005

Kaiser in CA does cover it. I called member servives and went to the dr too last week. Your doc has to say that the band would be better then bypass. In Ca you have to have one of serious comorbidities if you are 35 to 39 bmi. Pre diabetes or hypoglycemia doesn't count which is my catagory. Keep calling till you get the answer you want!

Crystalstar11 · September 3, 2005

I was told that Kaiser's HMO plan only covers the RNY. I have Kaiser's Flexible Choice plan. Now I have been told that I can use my options 2 plan which is PPO. I can get a PPO doctor to call Health International who will be the ones to approve me for the Lap Band or not. If not I can then file an appeal. I will keep fighting for what I think is right and I will keep my head up all way.

Karen