Question:
What are some good questions I might want to ask my insurance company?

I am considering having WLS but Im just a little scared as far as my insurance is concerned. I currently live in Illinois and I BCBS Advantage HMO through my job. So before I go and get myself emotionally amped for this I want to pretty much "grill" my insurance company. Ive done a bit of research on it myself online and Ive still manage to come to a mixed conclusion and would appreciate any and all responsives I could get. Thanks very much in advance! :)    — all_dat_jazz1 (posted on September 25, 2008)

September 25, 2008
Hi. I just had my surgery a week ago and it was covered 100% by BCBS HMO. But, before I started anything I called the insurance company and explained my situation and what surgery I was looking at and asked them: a) do you cover obesity; b) how much do you cover; c) what EXACTLY do you need for pre approval (ie dr. referral, some ins co. want 6 months of doc. weight loss attempts like weight watchers etc.. (which can be done thru your dr. also) then I went to a class on lap band (i got the realize band) and already knew what was going to be expected of the ins. company. They are usually really helpful and will tell you exactly what they need. Good Luck. Laura
   — Laura B.

September 25, 2008
check with your insurance company. it depends on the plan and coverage you have. I am a review nurse and work for an insurance company. The criteria for the surgery is 6 monthes of a supervised diet plan, a bmi > 40, or 35% with commorbidities, like hypertension, arthritis, sleep apnea, diabetes. a tsh blood test so they can rule out a thyroid problem, or any other correctable cause for obesity.and the following:Preoperative medical consultation and approval Preoperative psychiatric consultation and approval Nutritional counseling Exercise counseling Psychological counseling Support group meetings Failure to lose weight significantly or regaining of weight despite compliance with a multidisciplinary nonsurgical program including low- or very low-calorie diet, supervised exercise, behavior modification, and support, with possible medication( this is the 6 month supervised diet. Hope it helps. I have an appt Oct 23 to meet this Dr. about my lap Band. I have done weight watchers since dec 07 and have lost 41.4 lbs. Im hoping to get on with this soon myself :-)
   — Jackie R.

September 26, 2008
I got the diagnosis codes from the surgeon's office and called my insurance. They sent me their list of requirements.
   — gonnadoit

September 26, 2008
Call your insurance company and ask them to mail you a copy of the criteria you must meet. Read it closely, pay attention to the details, and follow it to the "T." It wouldn't hurt to follow up regularly to ensure the criteria has not changed. One of the "hints" my insurance rep gave me was to understand my insurance covers the treatment of morbid obesity, not just obesity. At each visit, I always verify the code used for billing purposes is "morbid obesity" not just regular old "obesity."
   — wenniewo