New CPT codes for LAP-BAND®

I was wondering if anyone had the LAP-BAND® done by alex argotte in paducah kentucky that there in surance wouldnt pay for it. Is there another way to go about paying for this procedure besides insurance that he offers.

Could I have a copy please, BCBS is just awful, I have jumped through every hoop possible, thank you so very much,Moonraker14@hotmail.com Becky (Thor.)

I have BCBS of ILlinois, and they are doing to me just what they are doing to you, I have jumped through so many hoops it not even funny. I have done everything they as, have it all in writting,but they still come back with I am lacking something I have 4 letters and they all say something else.

Tracy, What do you mean by Onederland? I have seen it in a couple of other posts, too.

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RDK





Dr.Marsden 4/9/08

I don't know if someone replied yet but Onederland means gettign down into 100s on your weight instead of the 200s.

BCBS in Mass will cover everything that Medicare does not pick up for me. Medicare will pay 80% and BCBS-MA will pick up the balance. So far so good, but I haven't had my surgery yet.

FYI-- a few years ago, when I was pre-65, BCBS-MA denied my big repair surgery for ventral hernia --and I appealed internally and lost (a necessary step) then took them to the state appeal (Office of Patient Protection) which cost me $25 and WON my state appeal. It is decided by an out-of-state physician who is in the same field and neutral. BCBS paid for everything, and I'm thriving after that surgery. Anyone in MA is eligible to use this appeal process. It is very well done, and the website has online track record of prior appeals and outcomes.

Persist. The climate is changing rapidly for reimbursement. Try using Medicare info as backup support for your claim, since many companies consider them conservative, and will match the coverage.
Good luck!

:bump:

Anyone have codes for fills? I noticed this was originally posted a long time ago.

Just curious so I can find out if BCBS will cover those after surgery as outpatient surgery or as a regular visit.
I've read many senarios here and am just trying to get a fix on the reality.
Thanks!

I had BCBS of Kansas city -blue care and I had my approval within 1 week and surgery scheduled within 2 weeks.

That being said our company changed insurance Jan 1 to BCBS traditional. (GM) I am not sure if they will pay for my fills now. So if any one else has GM BCBS traditional insurance and knows please let me know.

Thanks
Christie

My surgery was outpatient.

I've noticed that some of you mentioned a six-month dieting thing. My insurance paperwork also says that. What exactly do I need to prove that I've been dieting for 6 months?

From what I've read and understand myself, the diet has to be doctor supervised with monthly weigh-ins at the office and a nutritionalist has to also be involved. Some insurance plans require 6 months - some 12 months... not every plan is the same.

Some insurance plans except Weight Watchers/Jenny Craig. I would check with your plan for specifics. Call the customer service # for further explaination if you can find the info you need. Have them explain in detail exactly what they require!

Any new out there on codes for Tricare Prime code for fills. Seems the doctor I am going to is out for money and wont file with the corrected code. And if I pay for the fills with this code, I can't get any of the money back. Strange situation.

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Banded 5.2.08, 12.18.08 8cc

My policy has an outright exclusion for morbid obesity and obesity, so you are right the code did not help me. I have UHC Choice Plus but the plan excludes this. Why would a company exclude this coverage, in your opinion. It seems like it can only help to save health care dollars in the long run. I will pay for it myself. What is the cost in your area? I am in Buffalo, NY, do not have any price quotes here yet.

I need a DRG code so my hopital billing group can give me a price for out of pocket cost.

Any know the DRG code? It is three digits, that is all I know about it.

does ins pay for the fills? I am just getting started with all of this.

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Margaret
Hope to be banded by Aug/Sept
height 4' 11" wt.199lbs goal 125lbs
SURGERY DATE 12-09-08 !!! at UOP
goal 02-23-09 want to be 160 vegas trip!!!
goal 05-10-09 want to be 140 dts b day mo
goal 07-25-09 want to be 125 summer
start 199/ surgery 190/ current 180
goal 125