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gsparks61 | What ins company will pay for the lapband surgery?i,m in texas? |
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shiprepairwoman
 |
Most will to solve health problems but not for weight loss just because you want to be thinner.
Health problems might be things like heart failure or a bad back. |
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sarah314
|
Here's the deal: Every insurance company has policy options that will cover lapband surgery when the medical criteria are met.
The problem is whether or not you will be able to enroll in one of those policies.
The best option is to be covered through an employer group policy that does not exclude weight loss surgeries. (Employer groups have the ability to either include or exclude weight loss surgeries...it just makes a difference in the premium they have to pay. XYZ insurance company may cover weight loss surgery for one company's employees, but it might be excluded entirely for employees of another company. Because the employer chose to exclude weight loss surgery from the benefit plan.)
If you're talking about individual policies that you'll purchase yourself vs. coverage you'd get through an employer...you're going to have a tough time with that. First of all, if you truly qualify for weight loss surgery, you'll have a hard time finding an individual policy period...you'd be a huge underwriting risk. And finally, if you were able to purchase your own policy, its likely that weight loss surgery would be excluded for you.
So, what you need to do is get benefits through an employer, making sure that those benefits don't exclude weight loss surgery. And then go through the pre-approval process...where you and your physicians will have to demonstrate that you meet all of your insurer's criteria for approval. (The insurer will have a Medical Policy document which spells out exactly what criteria needs to be met to be approved...BMI, co-morbidities, etc.) |
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acermill
 |
Most insurers will not cover lapband surgery unless your excess weight is also accompanied by at least one of a few life threatening conditions which would potentially be aggravated by the weight condition.
Additionally, prior to authorizing the surgery, most insurers will also require that a medically managed attempt is engaged to lose the weight in conventional methods. If that fails, then they will consider lapband or similar.
You are advised to check with your physician regarding your medical qualification to obtain lapband. If you are not currently insured, you also may encounter problems with a 'pre-existing condition'. |
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kykeklunk
 |
obesityhelp.com is a site where the lapbanders gather.
they will give you all the free help and handholding you need. |
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Zarnev
|
You will find that the problem is not finding an insurance company that covers lapband but finding an insurance company that will cover you. Individual policies have a height and weight guideline, and if you are a candidate for lapband you will be out of the height and weight guidelines of most if not all companies. You should call a local independent agent who can find out if any companies will cover you. Your only other option would be to find a job with insurance benefits. You will not be declined on a group policy. However, the insurance companies will tailor the plan to fit within your new employers budget and lapband, or any other particular procedure, may or may not be covered. |
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Rachel S.
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I had gastric bypass surgery 4 years ago and Blue Cross/Blue Shield of Texas paid for it 100%. It was the best thing I ever did - I'm sure it has saved my life. I lost 110 pounds and feel great.
Tip: Whatever insurance company you go through, contact them throughout the approval process to check the status of your approval. Always get the person's name and that date and time you called. Note exactly what was going on with your approval (who's looking at it, what information they're waiting for, and when it's expected to go to the next step). If they tell you Kathy in dept. 142 is waiting to hear from you surgeon and should have something in a week, call back in a week to make sure she got it. Be diligent about this. Again, take notes and record who you talked to and what they said.
My doctor's office said my notes were exactly what needs to be done in order to make sure you get approved in a timely manner. My total out of pocket for this procedure was less than $100 and I went to a nationally recognized hospital in Cleveland, Ohio and had one of the best surgeons.
I know this is more info than you asked for. Hope that's okay. Anyway, best of luck to you. Feel free to email if I can be of any assistance! |
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