Has anyone NOT had a problem with their Ins?

[michelleintheoc 0]

Hi All,

I'm new here. Thank you for reading my post! I'm waiting on my insurance approval. I have Empire Blue Cross / Blue Shield PPO. My BMI is 41. I've given the LAP-BAND® a lot of consideration and I'm finally ready! I'm concerned because I see a lot of people had a lot of problems getting their insurance to cover the band. And they had a higher BMI than me. Is there anyone out there who did NOT have a problem with insurance covering their LAP-BAND®? If so, I'd love to hear from you! And also what Ins Co do you have? Thanks so much for any help!

[but3rfly 0]

I did not have a problem at all with my insurance. Or approval process. My dr knew what they required and we did all that prior to so they had all the info and were not able to send me on a wild goose chace to get all the tests they wanted. I started in the begining to middle of Sept and will be having my procedure on the 12th of November. It took less than a week to get a response back.

Good luck to you!!!!

Edited October 25, 2009 by but3rfly

[UpperWestSide 3]

I have Oxford and they did not require the 6 month pre-diet so that took out a big part. But my Dr's office really seemed to know how to handle the approval process. I followed their advice and it went like clockwork. My practice gave me a set of directions that basically gave me a step by step procss to follow and I had no problems.

[ffpandamer 0]

I had no problem with Aetna at all. My Doctor knew exactly what my insurance would need, and was insanely thorough.

Get your requirements ahead of time. As long as you meet them all, you can't be denied. And if you are, you'll already have the tools you need to fight them :thumbup:

[Patterba 6]

Hi Michelle,

I have BC/BS of MA PPO.. no problem at all, very quick easy process.

Good luck to you.

[1019Joanne 0]

my best advise is to contact your insurance company - see what the coverage is under you specific policy. Your doctors office is most likely well versed in the insurance coverages, and they can be an asset to you as well.

Best of Luck!

[isaviolinist 11]

I didn't have any problem with my insurance co. I have BCBS. My hospital is a "Blue Cross Center of Excellence for Bariatric Surgery" thus the surgeons and team have a lot of close contact with them and have no problem getting approval. I was also not required to do the 6 month supervised diet. Good luck!

[mystro70 0]

I have bluecross/empire and I was approved in 2 days they paid for the entire surgery and also pay 100% of the fill

[meldlc37 0]

I as well had no problem getting approved. My BMI is 41, I have Lumenos BC/BS. I as well did'nt have to do a 6 month diet or any of that.

Good luck and I hope it goes well.

[tendervitals 0]

I have blue cross/blue shield and I had to do all the tests and the 6 months wieght loss consultations but once they were all over with my surgery was scheduled and usually the doctors office has a person to deal with the insurance company.

[michelleintheoc 0]

WOW, you guys are amazing!! Thank you soooo much for the support, I'm truly grateful. I believe the Dr.'s office just put in for approval a few days ago and they told me it takes about two weeks. I will keep everyone updated. And thanks soooo much again! Michelle in the OC

[Bjsfinley 0]

I have BC/BS TX and I didnt have any problems. I had quite a few requirements (5 yr medical history, 6 month weight loss, psych eval, sleep study, etc) and I met all of my requirements except a full 5 yr medical history (I wrote a letter explaining why I was missing 2 years), submitted to insurance, and had an approval in about 10 days. I had my surgery on Oct 13th. Good luck! Go with an office that knows what it takes to get approval from insurance. Thats what I did.

[ParrotheadCathy 0]

Michelle, just don't try to compare your policy to someone else with a policy that is also Empire Blue Cross/Blue Shield PPO! A lot of people don't understand that each employer negotiates the coverage they provide their employees. So one person insured by your company might not have weight loss surgery coverage while another does.

The single best thing you can do is to call your insurance company now. There is a customer service number on your insurance card. Give them your policy number and ask if weight loss surgery/lap band surgery is covered by YOUR POLICY. If they say yes, then ask them:

1. Do you need a history of weight/weight loss attempts from my doctor?

2. Is there a minimum BMI? If so, what is it? And, should my weight have been at that level for a specific period of time (for example, my girlfriend was covered IF her BMI had been 37.5 for a minimum of 18 months).

3. What doctors and surgical centers are covered by my policy? (Bear in mind that just because your doctor choice is covered, he may use more than one surgical center and not all of his options may be covered by your insurance)

4. What requirements do you have to approve the surgery? Do I need consultation(s) with a nutritionist? A psychological evaluation?

In other words, do you homework BEFORE you get in too deep.

[michelleintheoc 0]

Thank you Parrot Kathy, You provided some extremely VALUABLE information! I hope others see you msg, so it will help them also. My request is in process and i'm pretty sure my Dr.'s office is really up to speed on how to approval. I will keep everyone updated. THANK YOU!