Insurance problems, new poster here.

[HETFIELD 0]

I am 6'0 and 360. 29 year old male. I have lost weight plenty of times in the past including with a personal trainer only to gain it back. Nothing new right? Well I have Horizon Blue Cross Blue Shield of New Jersey. I called Dr David Geller's office in Louisville as a friend of mine recommended his office. They told me to get all these facts and questions answered before I could even get into a seminar. So ok, I call my insurance and they tell me flat out they don't do lap band surgeries. I'm thinking..."OK?" And I hang up. I call back later and get a different person and they say the same thing. After I question them why, he relents that they don't do it for people interested in improving their looks. So I'm under the assumption that they do it for health reasons. Well, I have type 2 diabetes, and high blood pressure, and am on meds for both. So I'm thinking that's good enough right? Well, I decide to check my insurance booklet. That was tough to get from work as well. But I finally got it. It's pretty much greek to me, but looks as if they don't cover gastric surgeries to lose weight at all. So I'm wondering, are these just barriers trying to prevent me from obtaining lap band? How can I find out 100% truthfully if they cover it or not?

[FailureIsntAnOption 0]

I ran into the same thing with my insurance provider Kaiser Permenente. After self paying for the lap band surgery myself I learn that they do indeed cover it and I was given erroneous information. I have since filed a grievance with my provider and am waiting for the outcome. Funny thing is, they were really pushing the bypass which I am/was totally against. I think the reason is that the band takes much commitment to succeed whereas the bypass is a sure thing and doesn't require the adjustments/fills that the band does.

My advise to you.....keep pushing until you get your way.

[a-newme 0]

Not sure how big your company is, but you might ask if you have an insurance broker... I work in HR, and sometimes, the insurance broker can get answers from the insurance company that I can't. If you work for a large company, this might be harder to do, than if it is a smaller company. For larger companies, it is usually up to the employer as to whether gastro surgery is covered.

My insurance has it excluded as coverage. I had to self pay. If it comes down to that, I would choose a dr that includes fills with his surgical fee.