New CPT codes for LAP-BAND®

Agreed, however, it's not necessarily the insurance company that is excluding it.

Your employer chooses what sorts of procedures they don't want included in their standard coverage, and even though it may cost the insurance companies more in the long run, due to weight-related problems, it will cost your employer less in premiums because they aren't paying premiums to cover as many things.

At the end of the day, if your employer chooses to exclude weight loss surgery from their coverage, that's about all there is to it, unfortunately. :(

If your insurance will cover the surgery, they will cover the fills.

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Actually I found out that CHAMPVA will probably cover it. You were right about the employer and the cost to them.

Happy Cinco de Mayo.

Is the code, 43770, listed at the beginning of this thread still the valid code today? Also, is that a universal code number used by all insurance companies or just some? The reason I ask is because the clinic I'm attended collected my insurance info and told me it would be a covered procedure once I completed my 6 month medically supervised diet. I also have to get the Psych Eval and when I called my insurance company to see if this would be covered, they asked me what surgery I was getting. I told them it was medically necessary weight loss surgery. They told me weight loss surgery was not a covered procedure. I'm just wondering if the clinic refers to it as something else that would be covered. I have my second month weigh in next week and will ask them then. I surely don't want to go through the six month thing if it's not covered. Do you think I should call the Insurance Company with this code or just wait until I see the clinic next week? The suspense is killing me. Thanks, any input would help.

Be careful because there are variations in what a particular company will cover. For example, I have United Health Care Choice Plus. For many members on this chat it covered their surgery. Because my employer did not have the rider for the LAP-BAND® UHC does not cover it for me. You need to check with your employer and read your policy benefits. Confirm with Human Resources or call the prior authorization number on the back of your card.

I just got approved today. It took me 18 months!!! At first I had to submit letters from all my MD's stating it was medically necessary. hey required that you be at least 100 lbs. overweight & have at least 3 comorbidities such as diabetes, high blood pressure & have tried weight loss unsuccessfully for at least 5 years. Then the various diets I've been on, at least 5 yrs. worth plus 6 consecutive months of medically supervised diet & exercise - chronological Dr's. notes, not a summary letter. Once that was submitted, they requirred 12 consecutive months instead of 6. They try to wear you down. You just have to be persistent & don't give up.

I beleive that the code for fills is (s2083 -adjustment of gastric band didameter via subcutaneous port by injection or aspirationof saline.) I found this on a cigna healthcare postion coverage web page. It also listed the new number for the surgical part #43770.

This isn't always true. My insurance covered the surgery, but will not cover the aftercare. Fills are considered aftercare and are thus out of pocket for me.

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Surgery 6/30/08 10cc band
Dr. Adam Kaplan - Parkersburg, WV
6/26/09- Port revision scheduled due to leak!

I have BC/BS and i got my approvl letter. Had my surgery in Feb of 09. I paid $1000 for co-pay. Now i get a bill for nearly 27,000!!! I've called the hospital, and now dealing with insurance co. so far, there are no new sumbited charges. Noone will tell me anything. ....any suggestions

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Can anyone tell me If New York Medicaid covers this surgery. I have tried many diets, exercise daily and still i am at a platto, and i can't get my weight down. I'm tired all the time and i just feel BLAH!!!

Of course medicaid pays for it. It is our insurances that dont pay.

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"I gave up sex for food and now I can not even get into my OWN pants. But after that band, LOOK OUT!"

dont panic, I had my surgery in July of 2008 and it is still not paid for and I have two insurances. And the 27K is only for the surgery, that does not include the surgeon fee.

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"I gave up sex for food and now I can not even get into my OWN pants. But after that band, LOOK OUT!"

I just started this process and I'm going thru medicare and I was really surprised to learn even with medicare the copay for us is 7000 dollars for LAP-BAND® and 10000 dollars for gastric I wish they would pay more for this

Thread Starter

That doesn't sound right. Are your surgeon and hospitals certified as a provider for the Centers of Excellence? We've been doing Medicare Lap Bands for many years and this doesn't sound right.

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Dr. Ron Hekier, Texarkana LAP-BAND®®® Surgeon
LAP-BAND®®® Texarkana ( Texas | Arkansas )

http://blog.noscales.com
Disclaimer:
All information posted by me is my personal opinion and does not reflect views sanctioned by any other body or entity. Posts on this board should not be construed to be offered as medical advice or a professional opinion.

yes I just got a call from u of w and they r certified by medicare and that is what they told me. Didn't sound right to me either. I went to Meritier Clinic