Question

Hi Everyone. I have a question. I am scheduled to have lap band done on 9/30/05. I have gone through all the millions of doctors appointments and have only 2 left. I have my endoscopy scheduled for Tues. 9/6/05. I am not aware of any problems, so I am praying that goes well. Then, I have my last appt with the internist on Sep 12, where he will review all of my testing. My question is this, when should I know whether or not the surgery will be covered? How soon in advance were you all made aware? I do have high blood pressure, and have for about 15 yrs. I do know that high BP is considered to be a co-morbidity, so I am praying my heart out that it will be covered, but I need to know for sure in advance. I am a teacher, I need to give my principal a heads up ( I won't tell him what KIND of surgery I am having), and I need to arrange for a substitue. I am getting so nervous about the insurance. I have BC/ BS of DE. I spoke to an insurance agent last month, and she said that if I am obese and have a co-morbidity, it should be covered. I know I babbled, sorry, but if any of you could answer my question, I would be more than appreciative! Thanks so much!

I understand your delemia. I have BC/BS PPO of Pennsylvania and my authorization came in about 1 1/2 weeks after all paperwork was submitted. I would say to call your insurance company about 2 weeks after the Surgeon's office has submitted the necessary paperwork. I hope this helps and best wishes to you.

Carla.. I hate to be a downer but.. I have Aetna and after 58 days they denied my first claim. (Normaly they have to answer you in 45 days, but oh how convinient they "lost" my paperwork.) My appeal was APPROVED in 13 days (they have 15 days in which to decide an appeal). I pray you do not have any of the issues I had and that your insurance approves you quickly! Best of luck! Erin

They did deny me in Feb, when I initially had it scheduled. They said that lap band was considered to be "experimental." Then, in August, something just told me to call, BC/BS again, and they said as of June 1st, they began covering it if you have co-morbidities, which I do. So I had to go to the cardiologist (again) and the pulmonoligist (again), and I had to get another chest x-ray, because all of those have to be done within a 6 mos time frame prior to the surgery. I tell you what, I will fight this tooth and nail. They will pay for me to have gastric bypass, but get this.........I am not "Heavy enough" for bypass. Give me a break, have you ever heard of such a thing? How much sense does that make?

Actually I have heard of that because orignally that was why Aetna denied me. Aetna wants 5 years of weight history.. well at times in the last 5 years for a few months I could get my BMI below 35 with Xenical or Meridian. However my weight always ballooned back up. Anyway long story short as I said I appealed and won. BEST of luck! I'll keep you in my thoughs! Erin PS: If you go into surgery with out pre-cirtification (pre-determination) and your insurance denies you you will be stuck having to self pay whatever the bill is. Just an FYI. In MIchigan BC/BS does not pre-cirtify theses pateints go into surgery praying their bills we be paid