ok....from what i'm reading it sounds like the surgeon puts the band in but you have to find your own doctor to do the fills? is that right??
For those of you who were able to have insurance cover the lap band thing, did they cover everything, how much did you actually pay out of pocket??
What kind of doctors do the fills? How much is that co-pay i wonder. Is that like a specialist co-pay? hmmm...so many questions.
Tonight is the information session at the weight loss center so hopefully I'll get all the info I need there. I'm so excited! I wonder how I get the ball rolling. Do I sign up at the info session? Do I have to wait for my insurance to approve me? hmm... i sure hope they do because honestly if they don't i can't do this. I can't find work so its only my husband working and we're in the process of buying a house so we don't have money for this if we have to do it on our own.
Anyway on another note last night my husband busted out with "what do you think about the name Lexi?". I thought this was SO cute because I'm always the one saying "what do you think about this name? what do you think about that name?" and he humors me but he always says no to my names. But this time he brought it up! He even came up with a name. But i was like...nah. so then he goes..."what about Tessela?" and you know, i don't wanna be like "ugh NO" because he's being so cute I didn't want to discourage him. But gosh I think its the cutest thing in the world!! This is the man that wasn't interested in having kids. But little by little I see him looking forward to it. :) I was a bit surprised that he brought it up though since I told him we'd have to wait another year because of the lap band. But I never get tired of baby talk so I welcome it, :) Maybe this year will give him more time to prepare himself for children.
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My surgeon's office does the fills. Some people have to travel far to get a doc that is covered by their insurance (or cheaper for a co-pay) and they find another doc to do the fills that is closer. The co-pay is all up to your insurance. Some just have to pay the office charge (maybe $25) so have to pay a portion like 20%.
ReplyDeleteThe surgeon's office will hopefully walk through all the insurance process. The two I looked at did. I saw them first and gave them all my info. They came back a while later and let me know what my requirements were. I also called the insurance company directly to figure out what was required.
Good luck in your meeting!
The clinic I am going to handles everything: the pre-quals, pre-ops, surgery, & all of the after care. The fees you pay up front cover fills for the first 13 months. They are $185 ($150 if you don't have them bill insurance) after that and it includes 2 weeks of care after the fill, in case you need an un-fill I suppose.
ReplyDelete(Not banded yet, just started my insurance hoop jumping exercises.)
Look at all these lap-banders helping you out - I told you they were great!!!! So happy for you!
ReplyDeleteThe surgeon's office should definitely help you walk through the process.
ReplyDeleteHere's one recommendation that I would do ASAP:
Call your insurance company and make sure you don't have an exclusion for weight loss surgery. Use those exact words when you ask. Or, you can call the clinic, get the procedure code for Lap Band placement, and then when you call your insurance company, say exactly, "I'm looking to see if my policy covers procdure code 4077 (or whatever it is)."
I bet you've heard of those patients out there who submitted their insurance, it got denied, and then they had to fight for it, get extra paperwork, or get extra tests done, and then resubmit, and then maybe they got approved, or maybe they didn't.
What I'm getting at is there are two types of denial - one you can fight, and one you can't.
If your insurance policy has an exclusion for lap band placement, it's not going to be covered. Period. It doesn't matter what co-morbities you have, how overweight you are, how badly you need weigt loss surgery - it's just not going to be covered.
I recommend this 5 minute phone call because if you truly cannot afford to pay for this surgery out of pocket, I would find out as soon as possible what your policy covers. In my opinion, it would be awfully crappy if you went through seminars and consultations and pre-op work, all to find out that your policy will not cover (and never was going to) it because of an exclusion.
Does that make sense? I think it could really save you some heartache if take care of that one little thing before you really get going through the process.
My insurance has an exclusion, so there was no possible way my band would be covered, period. It stems from the employer - my husband's bank said just dictated that the policy they provide would not cover weight loss surgery.
I saved for year to cover my surgery.
I also flew from Omaha to Denver to have surgery, because I found a doc there that would do it for $10K, instead of the $16K or $17K here at home.
My doc in Denver will do fills, for pretty cheap, too ($30). But for me, it's just starting to be too big of a hassle for me to fly out there for a 15 minute appointment. That's why I'm starting to look locally for a fill doc.
I've spent the last two days on the phone calling any office I can find within about a 3 hour drive. I start by saying, "I had my band placed by another surgeon, would you do my fills?" Alot of offices won't take someone else's patient. If they say they will take me, I say, "My insurance doesn't cover fills, what will the self-pay price be?"
So that's what I've been doing regarding my fills. That's why you see me talking about trying to stay local.
Let me know if you need more questions answered! I can always give you my email addy, too!
oh my gosh you ladies are awesome!! thank you sooo much for the info!! really truly. it helps SO much! thank you!!
ReplyDeleteMy surgeon also did her own fills (all under flouro, amazingly enough). When she moved to Chicago, I knew there was no way I was going to travel every time I needed an adjustment. Luckily, she set us up with three other local docs that would take us. I've been very happy with the one I chose.
ReplyDeleteI was lucky and my insurance covered everything top to bottom. My fills are even covered 100%.
I have BCBS and had to complete a 6 month diet and exercise program before I was approved. I also paid $55.00 the day of surgery because that is what was left of my deductible. My surgeon also does the fills in his office.
ReplyDeleteInteresting. i wouldn't mind paying like $100-200. thats fine. i just can't afford $1000+ you know? now i wish i still had BCBS. but i have United Healthcare. Anyone else have that?
ReplyDeleteNot trying to beat a dead horse here, but I want to make a point -
ReplyDeleteWhile your insurance company certainly plays a part, it really has to do with what your employer has included/excluded on your particular policy. I actually have Blue Cross/Blue Shield, but my hubby's employer specifically excluded weight loss surgery, so I had no chance. Your employer has to pay for part of your insurance, and they save money by excluding this stuff.
But anyway, I saw in your newest post that you'll be calling your insurance company to verify. I'll be keeping my fingers crossed for you . . .
thanks kim. that makes me nervous. you can never tell what an employer will do to cut costs. my husband has always worked for start up companies so its entirely possible that they cut that out to save money. :/
ReplyDeleteMy doctor does everything, he put the band in, he does my fills. But this may be no help to you since I was a self-pay. So i dont pay separately for my fills. =/
ReplyDeleteI will pray for you - I hope your insurance covers everything!