Which Insurance Is Easiest to Get Approval??

Okay, I am wanting the lap band procedure and have an insurance question.  My family owns two companies and we currently don't have health insurance.  We are going to create a group health policy.  I live in KY.  Are there certain insurance companies that make approval easier than others??

Zander, most insurance companies are fairly easy at times to get approved for WLS IF the individual meets the criteria set forth by the insurance Company.  Now you indicate your family owns 2 companies.  Will this be a large group of employees?   Cause most small businesses with less than 25 employees they usually set up individual policies as a group and most individual insurance policies do not have WLS as an option.  Your in KY and if the companies are in KY you should stay with a known name company... Anthem, Humana, United Healthcare just to name a few in Kentucky\ Always when applying for insurance contract make sure there will be no EXCLUSIONS for WLS. Vicki

In KY a group can be anything from 2 employees up.  We have almost 20 with the daycare we own and 5 with our other.  I also see you had Dr. Rodriguez...is that the same one that does the surgery 10 minutes from El Paso, Texas???  Thanks so much for the speedy reply!!

No Dr. Rodriquez I go to is in Louisville KY and his office is downtown by Norton Hospital and he does his surgeries at Norton Hospital

Respectfully, I cannot disagree more with some of the comments.  It is NOT easy to get approved.  I cannot even tell you how many people cannot get approved even though they meet EVERY criteria and in many cases they are severe.  They show proof and jump through all the hoops and get denied for the most ridiculous reasons.   They are real people who fight and fight to get this surgery so I think its an injustice to say 'its easy" if you fit the criteria.   Also another big issue is some insurance companies criteria is so outlandish you would be to unhealthy for surgery if you did meet their criteria.  United Health Care is my hospitals insurance of choice.  Keep in mind they may look at your weight and the under writters may put a pre existing clause in there or exclude the surgery.  If you do have it included in the policy it may end up costing more of the policy than the actual procedure.  Weigh it out.  Best of luck. Lyns

Somehow I thought it was more difficult too.  I wonder how it works in the few states where there is state mandated coverage???

Hmm.  Good question and one I really can't answer very accurately.  I know that Medicaid and nearly all other state insurance or medical coverage does cover it here in arizona and fairly easy I might add.  This is what my hospital told me.  I have state insurance because my husband is a state employee.  When I got denied I appealed.  The appeal rebuttle was largely about how its discrimitory of the state to cover the surgery with my conditions for all other state funded plans but not their health insurance.  I won largely because of that.  No one including myself, hardly believed that I did, but I did.  Best of luck.  I have good feelings about this working out for you! Me.

Getting approved is not difficult.  Unfortunately many people do not submit the right stuff to the insurance company. The requirements need to be clear, the insurance sompany will not red through pages and pages of crap to find the co-morbidities or supervised dieting records. When sending stuff to insurance you need to send all the stuff in as few pages as possible and the top of each page should be clearly marked as to the content, example "psychological clearance" or "medically supervised diet visit 12/07" etc.  Far too many of our patients think that Cigna or UHC is going to look through 5 years of medical records, they are NOT! They will just deny it and say it was not there, you didn't meet the criteria, etc because it was too hard to find. Things like a medically supervised diet must show diet and exercise, not follow ups for medication refills, it is not the same. Just because they weighed you at your doctor visit does not make it a diet visit! United Health Care has one of the eaisest that I have worked with, some plans do not require a supervised diet. You only need a basic psych clearance, no special psych tests like some BCBS require and 5 years of weights. They approve quickly too. They worst ones I deal with are BCBS of IL and BCBS AL and Cigna. They are sticklers about supervised diets being not only 6 months but a full 180 days and notorious for telling me they have not received the nut eval or psych. I did send it! Wonder where they put it! Good luck! Bonnie

Great!  We are looking at United so maybe that will come through for us.  We are also looking at Aetna.  I appreciate your input.  Thanks!!