Quick question about insurance.

I'm not a US citizen, but I am hoping to move to the states within a year or so (Mostly depending on finding a job, getting visa and workpermits and all that jazz), and I was wondering, as long as I have medical insurance, will they consider helping me with covering for example the lap band surgery? I've tried to look it up around the net, but nothing so far. In reality I'm just curious if I even have the slightest chance of an insurance company helping, or if I should just start saving up for covering the cost my self.

Linda: Welcome to our country. I hope that you enjoy your time here and that you get what you are looking for. Regarding coverage for health care, depending on how you obtain your coverage and the type of coverage that you elect will dictate whether an insurance company will pay for lap band surgery. Are you getting your coverage through an employer? Do you plan to purchase an individual policy? As a general rule, lap band procedures are considered investigational by the insurance company and are not covered though there have been exceptions. You will have to inquire about the plan that you choose to find out how lap band applies to it. You will also want to be mindful of pre-existing conditions. Many health insurance companies subject new patients to limitations of coverage, depending on how long the patient was covered under his or her old plan. The best bet is to contact the insurance company to find out if there are any pre-existing conditions on your policy and how you can fulfill those conditions. Typically, if you can show proof of coverage from your previous insurance company (called a HIPAA certificate), you will not be subject to these limitations. There are a lot of other scenarios, but without knowing how you plan to obtain your coverage, it will be difficult to address them. I hope I provided some elucidation for you.

I'm not sure yet if I will end up with insurance through an employer or if I need to get it my self. I'm still in the process of applying for jobs, and haven't moved quite yet. But I believe moving so far away is such a major step that I'm researching all aspects now If the job I (hopefully) get offers insurance, I will most probably go with that. As it is now, I don't have health insurance. The health system here and home (I'm Norwegian, but currently living in Sweden) doesn't require healt insurance really. If I go too the doctors and get recommended/approved for lapband for example it would all be covered by the state. The only thing is that the waiting lists are quite long. But if it isn't to common for lapband to be covered either way, I guess I should start saving no matter what, just in case. If I would get approved anyway, it's not like saved money can't be used other places :p Thank you so much for your answer

Linda: The main thing that you want to realize is that if you purchase individual coverage, there are most likely going to be a lot of limitations on your initial coverage. Also, the guidelines for even offering you coverage is going to be stricter than if you were to obtain coverage through your employer. In my opinion, try at all costs to gain coverage through an employer. I do not want to destroy any hopes for you. There are insurance plans that will provide coverage for lap band; however, a lot of them do not. Since having lap band is important for you, please make sure you talk with the benefits administrator of your new company to find out if there will coverage for it. Also, if you are going to save money to prepare for the possibly uncovered lap band procedure, talk with the human resources department about setting up a flexible spending account. I am not sure if you are familiar with this type of savings account, so let me give you a brief explanation. A flexible spending account is a federally controlled savings account that allows you to set aside money on a pre-tax basis for non-covered medical services. You fund this account from your payroll dollars; typically, your employer will deduct the money from your paycheck automatically. Many people will use this type of account to save up for medical procedures that they plan to have at some point during the year. It is a great way to save without actually having to manage the savings yourself. There are some limitations that you want to be mindful of though. First, flexible spending account (FSA) dollars can only be used for medical services. You would not be able to withdraw money from the account to purchase, for example, food for your house. Second, you must use all the money in your account for any medical needs before the year ends, or you will lose it. Last, your employer and federal government will set a limit to how much you can put aside. There is a very interesting feature to FSAs though. When you set up your account, you tell your employer how much you want to elect for that year. Your employer will divide up the full amount of your election by the number of paychecks you will receive for the year. For example, if you are paid twice a month, and you elect $2,000 for savings, you would divide $2,000 by 24 (the number of paychecks you will receive), which would yield $83. So, $83 will be deducted from each check. The interesting aspect to it is that you can use all the $2,000 that you elected before you have even accrued it. So, if you want to have your $2,000 procedure mid way through the year, you will be able to do so and have the FSA pay for it fully even though you will have only accrued $1,000 in your account. It is the risk that your employer takes when it offers you an FSA. If you need any assistance or would like more information, please feel free to e-mail me at [email protected]. I would be more than willing to help you acclimate to our culture.

Actually lap band cannot be considered investigational since it was FDA approved back in 2001.  The insurance company may write that on a denial but usually overturn it on appeal.  The general rule is if they pay for RNY they will also pay for lap band.  Medicare and Aetna are now paying for the lap band procedure.   Jenn Y. banded 11/3/05 Port Replacement Surgery Scheduled for 9/21/06