Insurances putting a stop on lap band??

Kelsy · 02-17-2007, 10:36 PM

While i was in the hospital - My mom told me that the local news had a segment on Lap Band Sugery and they mentioned how it's becoming one of the "biggest it things" now.. HOWEVER, Insurance companies are getting sick of paying for them and want the person to go on a supervised diet w/ a nutritionist and all for ONE YEAR -before- they'll approve it.

Tufts Insurance has already began to enforce this new rule.. Has anyone else heard about this??

Jimboss · 02-17-2007, 10:40 PM

My insurance company made me be on a supervised diet for one year prior to my surgery. As far as supervised goes.........all I had to do was email them my food diary 3 times a week as well as an exercise log. There was never any checking me out or weighing in at all. The stipulation was I couldn't gain weight. If I lost any, fine. But if I gained I was disqualified for the surgery. Personally I thought it was a whole big bunch of BS but then if I wanted the surgery, I had to play the game.

Kelsy · 02-17-2007, 10:42 PM

I was wondering about that.. Cause i was thinking well if you LOSE weight.. they may just say "you don't need it" . you know?

Jimboss · 02-17-2007, 10:47 PM

If I had lost enough to put me under a BMI of 40, I would have been S.O.L. I didn't gain but then I didn't lose either. It was a pain in the ass year but today when I look back, it was worth it.

yukaputz · 02-17-2007, 11:20 PM

I was provided my ins with a years worth of receipts from weight watchers. They accepted it and me and the bandito are happily marred together now.

**Wheetsin** · 02-18-2007, 12:02 AM

The situation for many insurance companies is purely fiscal. It has to make dollars and cents because it's a business. This means the investment of paying for the Lap Band has to save them at least that amount in what they pay out. When you factor in the time that the averagte American of average banding age stays at a job, and the long term success rates, etc. -- insurance companies just aren't seeing great ROI. I had a conversation with a person who had worked at UHC when the "banding buzz" first hit. She said their average customer stayed with them for 3 years, but that it would take an average of 5 years to break even with their investment. I've heard the same claim (different numbers) from people who have worked for two other major medical providers.

My ins didn't require a supervised diet, but if they had, I wouldn't have had a problem with it. But I think it's a thin, thin band-aid to change someone's qualifying status because of any loss or gain during that time. They see from our records histories of losing & gaining weight. Of course we'll lose weight on a supervised diet, and we'll probably gain that weight once the diet is over. So if my BMI drops to 39 because I went on this diet, don't pull my qualifications, ya know?

sleepyjean · 02-18-2007, 12:24 AM

Quote:

Originally Posted by Jimboss

There was never any checking me out or weighing in at all. The stipulation was I couldn't gain weight. If I lost any, fine. But if I gained I was disqualified for the surgery.

Are you serious?They tell you you can't gain weight, but they don't actually weigh you themselves? What's to stop people from lying? That is so ridiculous. Why don't they just tell the truth - there's a mandatory 12-month waiting period because they're hoping you'll give up on the idea, pay for it yourself, or switch to another insurance carrier.

Jimboss · 02-18-2007, 07:21 AM

I should have clarified earlier....sorry. They took my weight provided by my physician at the beginning and then again what my weight was (also provided by my physician) after a year.