How to start the process

cc2129
on 8/18/14 7:26 am

Hello out there. I have recently decided to get the lap band surgery. I have done tons of research on the surgery itself but am not sure how to get the process started of getting approved through insurance. I have BCBS .The closest bariatric surgeon available to me in almost 5 hours away so I would really like to know if I can get approved through my primary care doctor before I start making trips so far away from home only to be denied. Any help or advice would be helpful. 

Thank you and good luck to you all on your own journeys. :)

poet_kelly
on 8/18/14 8:36 am - OH

Call your insurance company and ask what they require for approval.

Also, if you are sure you want the lap band, make sure the surgeon five hours away does them.  Many surgeons no longer do them due to the high rate of complications requiring removal of the band.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

MsBatt
on 8/18/14 9:06 am

I can not, in good conscience, recommend the LapBand to anyone. I certainly can't recommend it to someone who will have to travel five hours from home every time she needed a fill or an unfill. Please, PLEASE, re-think this.

You say you've done tons of research on the surgery itself. Have you also done tons of research on the other forms of WLS? (VSG/Sleeve, RNY/gastric bypass, and DS/duodenal switch.)

As far as getting started with your insurance company---CALL THEM. Have your insurance card in hand, and make sure they check exactly what your policy covers, what the requirements are, if you need a referral from your PCP, if they require a pre-op, doctor-supervised diet, etc.

 

Lmo2291
on 8/18/14 9:51 am

Hey there! I started the process in June with the intention of getting the lap band. However since then from talking to doctors and doing research I've learned that less and less doctors are doing the lap band because they're not really effective and there have been a lot of issues. My surgeon said he takes more out than he puts in. I didn't like the idea of cutting any major organs but after long consideration I've decided on the sleeve procedure. In terms of requirements you would have to call your insurance company to be sure but many require: BMI 40+ or 35+ with co-morbidities, doctors note, 6 month MD supervised diet, nutritional eval and a psych eval but it varies from company to company and plan to plan. Best of luck to you!

jessica1371
on 8/18/14 2:06 pm, edited 8/18/14 2:06 pm - Elgin, IL
VSG on 08/29/14

Which BCBS do you have. I have BCSB of IL. I called them FIRST, and asked what my requirements were. BCBS of IL said: 

Surgery HAS to be preformed at a Blue Distinction facility!!!

(3-6 month supervised diet not needed anymore)

and

  • BMI had to be at least 35+
  • Recommendation from surgeon, that surgery is necessary.
  • Psychologist evaluation (with clearance)
  • Nutritionist evaluation (with clearance)

My surgeon provided me with all the numbers, resources, and appts needed for approval thru insurance.. they REALLY know what they are doing. My office was awesome on the approval process. They made sure everything was done. They submitted to BCBS on July 30 and I was approved a week later!!

I didn't even need to see my regular doctor for the approval process. I mean my regular doctor knew I was planning it and I have to have a pre-op appt for clearance this Friday, my surgery is Aug 28th. 

Now my surgeon ALSO had their own set of requirements:

  • Weight loss Seminar
  • Surgeon consult (ok to use BCBS eval)
  • Abdominal ultrasound
  • Attend support group 
  • Psych eval (ok to use BCBS eval)
  • Pulmonary eval 
  • Nutritional class 
  • Dietary eval (ok to use BCBS eval)

 With that said I do agree with the above posters that the lab band is becoming a thing of the past, plus do you want to drive all that way  every week post op to get adjusted?

Biggest thing is call BSBC FIRST!!! They will let you know what the process is!!

 

Good Luck to you!!!

 

 

STATS: 5'7" HW: 424 (Jan 2014)   SW: 391 (Aug 2014)  CW: 323 (Jan 2015)

    

newlifetax
on 8/18/14 10:43 pm
DS on 10/27/14

Your surgeon's office *should* call your insurance company to make sure you have the WLS benefit and see what they require for approval.  After your initial consult, you will have to do a series of pre-op tests to make sure you are healthy enough for surgery and to make sure there is not some underlying medical issue causing your obesity.  You can probably do all the pre-op stuff locally and have the results sent to your surgeon's office.  I'm doing my pre-op testing at places that are close to my home or work.  My surgeon's office assigns each patient a "case worker" who takes care of making sure I have all my pre-op stuff scheduled (she did the scheduling for me on some of it).  Once all my results are in, I will have another consult (called "results visit") and the surgeon's office will submit all the paperwork for BCBS to review.  Once approved, I have to pay the surgeon the co-insurance amount (20%) and they will put me on the schedule for surgery.

 

That is the process my surgeon's practice follows.  Your best bet is to call the practice you plan to use and ask them what their recommendations are.

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