I am new, considering banding, don't know where to start

[espeon 0]

Hello, I am 40 and live in the Washington D.C. area. I have a BMI of 35.5 or 36, depending on how I list my hieght (5 foot 2 vs. 5 foot 3). I also have weight-related Depression and very high blood pressure, so high that I've gone to the ER twice.

I want the band, and want to be sure I get approved. I have Aetna. The first thing I want to know is: will they approve wls, and will they allow lap-banding. If yes, how much will they pay. I think the most efficient way to find out is to call them, but will this raise a flag that sets them looking for ways to deny?

Should I simply start by going to the doc? I can def. document this weight, plus weight loss attempts that at first succeed, but ultimately fail when I gain back all the weight.

Also, i am on medications for depression that cause weight gain by increasing hunger. Will that be an obstacle, either in terms of approval or in terms of success for the band?

My weight definitely causes and worsens Depression symptoms, easily documented by my psychiatrist and therapist.

Please forgive me if these things are addressed in existing forum questions; I have searched but haven't seen my specific concerns show up. Can anyone advise me about any of the above? Thank you!

[RestlessMonkey 7]

Welcome! Honestly you're going to have to call the ins, I think. Employers can modify policies, as can state laws etc, and so one person's Aetna coverage is not necessarily YOUR Aetna coverage. Call and find out what the requirements are. They are probably listed in your book but who keeps those things? Perhaps if your ins has a website you can check there.

Many policies which DO cover banding require, with a BMI of 35 to 40, that you have a comorbidity or two. I'm honestly not sure what they are, but again it varies by policy.

Good luck; start your journey with a call to insurance. I hope it works out for you!

For years I put this off because my insurance didn't cover it. I finally decided I was worth the price of a compact car and started the ball rolling when I received info that my insurance WOULD begin finally to cover, retroactive to 1/1/2008. So even if your ins won't cover, don't despair.

Edited June 1, 2009 by RestlessMonkey

[espeon 0]

Thanks so much, Restlessmonkey! I will see if I can decipher the material online before breaking down and calling an insurance person. I just have this fear that a call would trigger their efforts to block the surgery, lol. Thanks again.

[RestlessMonkey 7]

I understand your concerns and don't honestly think you're being even a little paranoid; I've read some true horror stories here about people being denied because their BMI was 39.9 instead of 40 for example (not specifically w/Aetna...but just any ins)

However...if you can find it in writing, then you have a legal ground to demand your rights.

I called my ins, Tricare, 3 times and each time was told "no we don't cover lap band" . Then I got a military flyer discussing how tricare had covered it since Jan 1!

I don't know if those 3 agents were intentially lying or just hadn't gotten updated training (and were too lazy to look) So..I understand your reticence.

But it's something we all eventually have to bite the bullet and go through. Some people get so frustrated they just "self-pay". Not all companies are so inaccessible, though. Hopefully your experience will be a good one.

Once I had proof that tricare paid, I actually was approved in under 48 hours. So good luck!