Trying to get surgery need help with insurance quiestions

Hello i was working on getting lap-band surgery and denied by regence blue shield. Letters didnt work just denials. Well i am getting married jan 1 2005 and my new husband has group health options through his work does anyone know if they cover the surgery and if because it is already pre-existing will they let me get the surgery? I was told that they cover only gastric bypass which was my original choice in the begining? please help me if possible with any info. Because I am not on the plan yet they will not give me any info. thanks steph

Hi Stephanie, I haven't had surgery yet and I have a different insurance so I'm sorry I can't help you there. I do know that as long as its-"medically necessary", that legally most of the time the insurance has to cover it. Take pictures of any visible problems, document health through your pcp and fight. It shouldn't count as a pre existing condition, at least I don't think so. I have a self funded insur. through my husb's work and though its a really good insur. It doesn't cover surgery "regardless of diagnosis". So I just sent off a packet of info. to the board to review, asking them to approve alternate benefits due to medical necessity. They responded within 2 days saying they would discuss it at their next mtg Jan 21st. So I'm still on hold. I can't legally make them pay because they are self funded they don't have to follow all of the same rules as other companies. I live in Tacoma and we're trying to move to shelton. We're going to list our house after New Years. Then we're determined to find a cozy cabin on a lake. We're looking at Phillips, Spencer, & Nahwatzel primarily, possibly Mason, but its pretty spendy around that one. Its good to know there are others over there to relate to. Good luck with the approval. Good luck and Congratulations on the wedding. And Happy Holidays.

Sorry, Group Health does NOT cover lap-band surgery. I just called them yesterday and they said that they ONLY cover a traditional RouxNY (sp ?). Besides, they also told me that you have to PRE-PAY a bogus $1000 after-care nutritional program before they will even consider you for surgery. What a bunch of crap! I couldn't believe it when they told me that! I think it is their way of milking everything they can out of us "unfortunate" overweight people. I was extremely disappointed with Group Health, so today, I changed my insurance plan to GEHA (federal government hospital association) because they DO cover lap-banding and they seem to be very supportive and accommodating. The only thing GEHA wants is a BMI over 40 (or 100+ lbs. overweight). They then review your chart and make a decision. If you have a chance, I would DEFINITELY think about changing from Group Death (Health)!!!!

OOOOPPPPPSSS!! Sorry I kept saying "Group Health"....I really meant to say Blue Shield!!! I called so many different insurance companies yesterday that my mind is spinning! Blue Shield also does not cover Lap-Banding.

I have Regence and they don't cover banding procedures (considered experiemental so far). Depending upon your plan, they do cover the RNY. I've heard that Group Health won't cover bariatric surgery in the new year.