cash and financing

My insurance company denied me; I appealed & was ultimately denied because I don't meet the criteria of a bmi over 40 for 5 years.   I changed insurance companies to Aetna - just got the same response.  I'm not FAT enough?????????????   I can tell you I am.    Now I'm trying to find out surgery costs in the area.  I would like to get the band but I am concerned about traveling to get surgery  just for price.  But also I can't spend a fortune.  I'm just trying to find out what's out there.  I want it as a tool for my weight loss.  I've struggled since I have been a kid.  Also if I'm lucky enough to achieve this.  Down the road if there is every a complication will insurance give me a problem?  thanks

hi deb sorry u are having problems with getting surgery approval. i used a very nice surgeon right in hamilton and he operates at RWJ in Hamilton.  his name is dr. earl noyan and i really liked him. i had my surgery 10 months ago with him and would reccomend him.  i know he does lap band and RNY. good luck, jacki

hi there did aetna tell you why they denied you? i have aetna and had surgery a little over 6 months ago -- i was approved in 2 weeks -- did you do the 6 month diet that they require? do you already have a surgeon? i haven't opened your profile yet -- do you have a BMI of 40 or a BMI of 35 with co-mobidities?  roberta

I have aetna too - DENIED! :( found out friday Jean BMI 44 - hypertension, sleep apnea, adult onset asthma, knee and back pain...... WTF?

Wow, I am shocked!!! Did they say why they denied you? Because it sounds like you would meet the physical criteria easily!  I have Aetna, too, and they approved me very quickly.  The only thing they didn't have in the original request and wanted was a five-year weight history from my doctor, but once they got that, boom, approved. 

I just called Aetna to get more info.  Turns out my policy does not cover WLS. Period - end of story.  They don't even cover nutritional counseling(unless you are diabetic). I'll bet if I added up all the claims I've submitted for conditions related to obesity(BMI 44) - and those yet to come, that it will be costing them lots more than the cost of WLS!! Guess I'm SOL - Go figure!? Jean : (

I know that what is covered varies by exact policy held by your employer, because we have Aetna, too, but it is covered under mine.  It totally sucks that yours does not cover it.  :-(  I totally agree about the cost of the comorbidities and I think that is why more policies ARE covering it -- when the policy people do the math, they realize they are paying for more.   What if you tried to approach them that way?  Maybe total the actual cost to them for all your comorbidies that are weight related like the CPAP and the diabetes medications and supplies and anything else, then multiply it out by how long you expect to be on their program?  Maybe you can prove to them that it would be cheaper to just cover the surgery instead.   If that doesn't sound reasonable, what are you thinking of as your next step?  Any chance you can change insurance policies some how?  I don't know what the true cost is now, although I have heard estimates of $25,000, but if I find out when the claims process against my own company in July, I'll tell you.   I am SO sorry you're in this situation.   Jacqi

 

 

I am so sorry that you are having difficulty with Aetna.  I know the insurance companies are making the surgery harder and harder to get approved now, we have been talking about that at groups lately.   I had a friend who went to Mexico and had gastric bypass surgery, and then went back for her plastic surgery about a year later, and she did great there.  She had surgery in a hospital and then recovered in a 4 star hotel for about another 10 days each time... she said it was great.  The nurse/doctor come to the hotel to check in on you.  I think the surgery cost her about 10% of what it would have cost here.  My surgery was 9 months ago and the total bill was about $37,000.00.   She paid less than $4.000.00 in Cancun.  I am sure someone else would have more details if you post asking about surgery in Mexico, it's pretty common.

Michelle

I would never personally leave the country for surgery.  However, if you call the surgeons you are interested in and ask them about cost they will certainly give you soem information.  I know the surgeon I used has the information on his website about the cost of a lap band.  Also as far as financing is concerned some credit card companys and credit unions give loans for medical services.  I wish you the best of luck.

Hi all, just visiting from NY & this cought my eye.  As far as traveling to Mexico for banding, I did it and was very happy.  I developed a problem not related to the band & am having revision to RNY on 6/18...have Oxford Freedom now & was approved right away.  (when I had the banding I had no WLS provision in my insurance.) Regarding Mexico, I have never heard of banding or RNY for $4,000.  If you look on lapbandtalk.com, there's a whole section on "Mexican Bandsters."    Dr. Ariel Ortiz was my surgeon and he is one of the best.  My banding was about $9K, with hotel included.  The rock-bottom price I've heard is around $7K, but most of those doctors seem to be in question. If anyone does go to Mexico, I cannot stress enough that you must have aftercare in place here.  You have to make sure in advance that you have someone who will follow you for your fills and any diagnostic tests necessary.  Especially since we are not so close to Mexico, if you have a serious problem & no aftercare lined up, you're in big trouble. I did have aftercare lined up, a nurse practitioner who does fills on LI, NYC & Westchester.  She saved me on the occasions that my band closed up & I couldn't even hold down water.  Again, it wasn't the band or the surgeon, but an esopagus problem. Hope this helps some.  If you need more info, check out lapbandtalk.com and feel free to send me a message. Take care, Karen