Question:
What is Lap requirements???

I called BC/BS today and they said they covered the Open procedure and would cover the Lap if it was DR. required and as long as the surgeon sends a Surgery Operative report when they send for approval. I asked what exactly did this mean and she said she didn't know. lol DOES ANYONE KNOW WHAT THIS MEANS?    — meltedbuttr (posted on October 21, 2002)

October 21, 2002
Different surgeons have different requirements which depend largely on their own levels of experience and expertise. Our surgeon is a board-certified thoracic/vascular surgeon who is also board-certified in bariatric surgery, and specializing in laparascopic WLS. He evaluates each patient on an individual basis, routinely performs lap WLS on patients weighing over 300 lbs. (several weighing up to 600 lbs.), and has performed over 1400 lap WLS surgeries to date. Most surgeons will send a "sample" operative report which describes a "typical" laparascopic procedure if requested. Many insurance companies who have dealt with a large volume of claims for laparascopic surgery are very aware that in the event of "routine and uncomplicated" lap surgery they will experience a significant cost savings due to the shorter length of stay in the hospital, and decreased incidence of complications. Again, experience and expertise on the part of the laparascopic surgeon is everything. Good luck!
   — Diana T.

October 21, 2002
Some insurance companies do not like to cover lap because it costs more, or they will only cover the same charge as open. Lap takes longer, therefore, it is a longer OR room charge, more anesthesia, longer time for the surgeon, etc. I had lap and I was very happy with it. The recovery was very fast and I have minimal scarring. However,I have heard that my surgeon is no longer performing lap rny because of these issues with insurance.
   — Linda A.