Insurance Switch

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Hi banders in Tennessee!
I haven't been on this site for awhile. Lastly, I found that Blue Cross Blue Shield would not cover the LAP-BAND^®. So I pittled around awhile, trying to think of ways to save money for the surgery, thinking of my options. Finally, my husband came home with some encouraging news. His employer was planning to switch the insurance company to United Health Care. I recognized this company as one that has paid for the LAP-BAND^® on several occasions. Now I can only hope the plan my husband and I are under will suffice. I have heard both good and bad things about United Health, regarding the LAP-BAND^® procedures, but at least it's a start! Does anyone have any suggestions as to how I should handle this company?

Hello, just to let you know this is the first time in my life I have ever talked with anyone over the net. I read your question and I felt I had to answer. I have United Health Care, you have to be approved for the LAP-BAND^® and that took alittle while, about 6 weeks,I bugged them to death, just make sure the Dr you chose is in network. For my first visit I had to pay $250.00, If I had chose a Dr. that was in my network I would have gotten it back. I had to pay $125.00 for the surgery and that is for outpatient surgery. if I had to stay longer than 24 hours I think it maybe is $100.00 more. I had it done back in July, and I am doing fine.

I live in Gallatin, Tn Where are you from? There's not a lot of Tennesseans in this group are there?

My wife and I are driving from Shelbyville to Dalton Ga

Nashville is far behind in Banding.

What do you mean? I agree it needs to be more doctors, and hopefully theat'll change soon. I f people would look at the Band compared to the other. Ya know?

Hi, This is the first time for me to ever sign up to talk on the internet, I'm a little overwhelmed. But, for United Healthcare...my company has UHC. I could not use my insurance for my band. Our company put a "direct contract exclusion" to any weight loss surgery of any type in our contract with United. Therefore, even if they would pay for the surgery, our company negotiated to NOT have it covered. So, what I'm getting at is...whomever the benefits person is at your husband's company has the ability to ask for any type of "direct contract exclusion" to help on the cost of insurance to the company employees. (could be good or bad) In my case, it SUCKS!! I had to selfpay, and yes I do have a chip on my shoulder about it!!

What is the reason that they are not covering you. I went to Centennial in Nashville, Houston did my band and it was covered at 100%.

Well, United Healthcare states, "your company negotiated a contract with UHC that excludes any type of weight loss surgery of any kind." So therefore, even if united would have considered my claim, my company does not pay them enough for health care that covers any type of weight loss procedure. Do you understand? United would have probably paid for it, but my company put a "direct contract exclusion" in the contract for health care priviliges that have anything to do with weight loss.

Twenty-eight years ago, when almost every other doctor/hospital on the planet had FINALLY figured out that fathers should be in the delivery room, MY doctor (and Vanderbilt) were still keeping them out. Kid born at Ft. Campbell.

what part of Tn are you in? My doctor is wanting to do more LAP-BAND^®. He will work with you and may even cut some costs.. Let me know.

Dr. Morton, Southern Hills Medical Center, placed my band on 9/15/2003.

I would not say that Dr. Morton or his staff are behind in the banding experience. It has been a good experience and they did not take their time getting me to the fill level I needed to be at (3.0 cc). I would recommend them to anyone.

I had United Health Care. My company allowed the banding and paid for the surgery. I am in an appeals process right now to get my fills payed for.

Good Luck.

Kathy

__________________
Kathy

Banded 9/15/2003
Dr. Morton
Largest 218 5'1 1/2"
Pre-Op 202.5
4/20/04 163

Kathy, tell me, tell me... Dr. Morton did my surgery just last week. I really like he and Shawna. What was your experience like? When you were banded, how did you feel? I think I am just now starting to really be able to "feel" things. Like, I can actually tell that if I eat a pc of bread, it feels thick inside. I can't wait to get my first fill. How much did you get the first time? What happens afterwards?

Shawna is great to work with. The fills are done in the office with no xrays. It is simple and quick.

My first fill was 1.6cc's. My second put me to 2.6. I then went to 2.8 and 3.0.

I am not saying that this is how your fills will go. Everyone is different. I believe that it is a continuous learning process for Dr. Morton's staff and they may approach things differently than they did when I first started getting the fills.

I believe I am ok right now. I have to pay attention to what I eat and can not eat breads (and I do not miss eating breads). I am getting in my water and exercising. This has been such a positive experience.

I'm signing off now. I can't wait to leave work and walk a couple of miles in the hot Tennessee sun.

Kathy

__________________
Kathy

Banded 9/15/2003
Dr. Morton
Largest 218 5'1 1/2"
Pre-Op 202.5
4/20/04 163

Do you have any idea if Medicare will pay for this? Pat