New Insurance?

Hi all! It has been a long time since I have posted in here, but I have a question.  I was covered through my employer's insurance to have the Lap Band surgery over a year ago.  Problem is, I have now been laid off from my job and must obtain private insurance.  One that I have been looking at is United Healthcare but they have an exclusion for covering any type of weight loss surgery.  My question is since I have already had the surgery done, would it be possible for fills and anything related to the band to be covered under the plan?  I have researched and my surgeon is in the network given the fact that he treats other conditions concerning the stomach.  I am a little confused as to how this can work.   Anyone ever been in this situation?  

Thanks all!

I'm going to guess, if weight loss surgery is excluded, a fill, per se, is not going to be authorized as a separate and distinct code.  However, a doctors visit and various treatments, not using a weight loss surgery code, would be, especially if the surgeon is within network.

I'd be forthright and express your concerns to the surgeon's billing office, particular on what codes they would use for the fill.  And, then, ask your insurance about whether they would cover those codes.  When you talk to your insurance about use of those code, use the generic term "medical services," vice the specific term "lap band fill."  My guess is that the code is going to be specific about being a fill but I'm not all well-versed about medical coding.

The primary reason I'm recommending that you ask before you have a fill is because, bottom-line, it's going to affect your out-of-pocket cost.  It's hard to budget without having adequate data.

If your insurance will not cover the fill, you might qualify for some sort of grant from WLSFA or another group or, possibly, some Medicaid or other public assistance due to the unemployement.

I hope you are pleasantly surprised and that your insurance will pick up the bill.  I also hope that, if you are looking for another job since you have been laid off, you get one soon and that it has insurance which will cover your fills.

Thanks so much for responding!  I will take your advice and talk to someone in the billing department!

Is COBRA out of the question for you? That would allow you to continue your current policy.

I have UHC with a bariatric exclusion and was told they won't cover fills. I had to pay $225 out of pocket every time I had a fill or unfill consequently I didn't get many and eventually just got emptied because I kept tightening up anyway. Most docs won't fudge the truth about why you are there either so you may be stuck like I was.