Will Insurance COVER ME?!?!

Alizmarieo · 06-10-2007, 10:15 PM

What are some reasons insurance companies WON'T cover lap band? What are some reasons that gurantee they will cover it? THANKS

texgal61 · 06-10-2007, 11:08 PM

I have BCBS of Massachusetts (PPO plan). They will cover 90%: if you use surgeon w/n network; if your BMI is over 40, or over 35 w/1 or more co-morbid conditions (i.e., sleep apnea, high bp, diabetes, coronary artery disease, etc). I also have to get med records from my PCP showing my weight for past 5 yrs. I hope this provides some helpful insight.

**Alexandra** · 06-11-2007, 09:02 AM

Quote:

Originally Posted by Alizmarieo

What are some reasons insurance companies WON'T cover lap band? What are some reasons that gurantee they will cover it? THANKS

Alizmarieo, every carrier is different with regard to their medical review procedures. And large group policies vary considerably with what is covered and what is excluded--the only way to find out what's excluded on your plan is to read your plan documents or speak with your benefit adminstrator.

There are some general rules, however, for coverage of bariatric surgery. They are:

--Your plan must cover treatment for bariatric surgery for medically qualified patients.

--Medically qualified people are those who: Have a BMI of 40 or above; or who have a BMI of 35+ with two co-morbid conditions (these are health conditions that are caused or made worse by excess weight). These are the criteria necessary for a patient to be diagnosed with morbid obesity.

--In many cases, insurers also consider that people with a diagnosis of morbid obesity must have been MO for at least five years befor they will approve bariatric surgery as treatment.

--A psychological screening is necessary to test for eating disorders or psychological conditions that would interfere with treatment.