My insurance says the won't cover the Band

I just spoke with my insurance company, and they say the won't cover the Lap-band.  What do I do now?  I am so disappointed, but I know that there are other ways I can make this work, right?  I can not self-pay.  I just don't know what to do! Does anyone have any advice for me? -Sara

Hi Sara, I know you said self pay was out, but check out Capital One financing. They have some interest free plans. Mark

So what WLS surgery will they cover?  Are any of them an option for you?  Some insurance companies will not cover lap-band because they still consider it too new, or they do not want to pay for ongoing fills and maintenance of a medical device.  Stupid, yes.  Unusual, no.

I don't know why it would be too new since it's been the gold standard in Europe for 20 years hehehe  To be honest, the fills are just as expensive or maybe even less expensive as the follow up appointments and injectible vitamins that RNY patients need.  I guess it's just the cost of the device itself.  The cost of the surgeries should be the same, but with LapBand you have another $10-$15k for the band itself.  My insurance company didn't want to pay for fills but I appealed based on the fact that if they didn't pay for them (assuming I wouldn't pay out of pocket) that if I were to stay fat they'd have to pay for lots of insulin and other meds. The cost of the fills are cheaper than the drugs I no longer need. :)

If you live in the state of maryland your insurance co MUST pay for WLS as long as the criteris are met (BMI over 40 or under w/ comorbidites etc..)    It is Maryland law. I just went thru this when my insur said they will only pay for RNY. They are wrong the law is worded "or other surgery". I believe it was changed in 2001.    It is your body and no one can tell you what surgery to have.  It is a decision btwn your doc and you.    You MUST be confortable with the surgeru you choose. I dont have a direct link to view the law itself but you can do a search : "senate bill 436 maryland general assembly"   (Senator Britt)  this will reference to an analysis of current law.  "Health insurers and nonprofit health service plans. health maintenance organizations and managed care organizations must cover treatment of morbid obesity thru gastric bypass surgery or another surgical method recognized by NIH as effective for the long-term reversal of morbid obesity and consistent with NIH criteria"  Lap band is approved by NIH as an effective surgical method. Weh I pointed this out to my insurance co and they consulted their lawyers... VOILA!   BUT only the surgery is mandated.. depending on your insurance you may be stuck paying for the pre surgery tests.. Check out every angle and dont take no for an answer. I do have to mention that some insur co are excluded form the law ..  there are always exceptions.

kelled44- Thank you for this information.  I think it will be very helpful.  I met with my doctor today and she said that my insurnace agency DOES cover the band, but that my specific plan might not.  I'm hoping that this can be resolved.  if not, I apparently have the LAW on my side! hehehe.

Appeal it! I had to appeal my RNY because my "plan" didn't cover it but just one appeal letter and I got approved! Don't give up!

BCBS initally rejected a band for me.. in fact, rejected me twice. I appealed to the state and won on that level.  Dont give up. By the way, the maker of the band (Inamed at the time) has a group to help in wrting an appeal for the band. Barbara