Worth the fight w/ insurance?

[arthukd 1]

I have been considering LapBand surgery for almost 3 years now. I attended a seminar about 2 years ago and did not proceed b/c I had a BMI of 36 and no comorbidities. At the time I was not willing to pay for the surgery myself and have tried several attempts at loosing weight but always end up back where I started. I have decided it is now something I am willing to pay for myself. I have been overweight my entire life and saw a doctor about it when I was around 8 years old. In January of this year, I was told I have the early signs of arthritis, at age 30! I was wondering if it would even be worth fighting with the insurance. The main reason I am curious is because I have a small window of time in January that I could schedule the surgery or I will have to wait until May because of my job. If I think insuracne will pay for it I would wait until May but I don't want to postpone surgery and end up paying for it myself. Any thoughts??

[ParrotheadCathy 0]

Well, I think I would call my insurance carrier and ask the following:

1. Does my policy cover weight loss surgery, specifically the lap band?

Note, if there is a "written exclusion" in your policy against weight loss surgery, there is no avenue of appeal.

IF YES:

2. Ask for their exact requirements for approval.

3. Ask how long the approval process takes.

4. Ask what pre-op testing they require, if any. Most would be at the discretion of your surgeon.

5. Make sure the surgeon you want to use is on the approved list for your policy.

6. Ask if there are specific surgical centers/hospitals you must use for the procedure.

7. Ask specifically what your out-of-pocket costs would be (deductible, co-pays, etc.).

When you have these answers, you will know what to do.

Good Luck.