Anyone Out There Have Pacificare Hmo?

kat72 · August 26, 2005

I just wanted to know if anyone with Pacificare (HMO) has had the lap band surgery approved through this insurance. I called them and was told that only the RNY and the vertical banding are covered. I was just wondering if anyone has been successful in having them cover the band even though they say they do not.

aneffie53 · September 3, 2005

I'd say go ahead and submit the requests through your doctor. I was told absolutely not but they were my secondary insurance so I kind of excepted that. My doctors office sent it in any way and low and behold got back an approval letter. Just had my surgery!

kat72 · September 3, 2005

aneffie, thank you so much for your response; it has greatly encouraged me. The dietician that I have been seeing has just giveb me the ok to make an appt. to see the surgeon (9-22) since I told him that my insurance told me that the lap band is not covered. He does not want me wasting my time.

Jack, thanks so much for your info. as well. BTW Pacificare does cover RNY as well as vertical banding. I don't want RNY and I don't even think that vertical banding is performed anymore, not that I would want that either. I suggested that they updates their info. They were not too thrilled about that. I'll ask the surgeon about his experiences (if any) with pacificare HMO patients as far as coverage for the band. Once again, thanks to both of you for the info.