AllBodySurgery.com - insurance that covers weight loss surgery?

insurance that covers weight loss surgery?

I am from Oklahoma and need to know if there are any insurance companies that will cover weight loss surgeries? And can anyone tell me from first hand eperience how the procedure works and the cost of the surgery?Any information is helpfull. Thank you

Public Comments

A lot of companies will cover the cost of the surgery... it all depends on what your coverages are, what the exclusions are, and how much you're willing to pay.
Friend just had this done in Chicago -- Blue Cross, Blue Shield. She weighed over 500 pounds. It cost her about $500 I think for the whole thing. She had to stop drinking all sodas (she used to drink a Mountain Dew 6 to 8 pack a day), stop eating pounds of french fries at a time, etc. She had to prove there was no other thing that would help her to loose weight. I also have 3 in-law relatives that did this. They lost a lot of weight. They all gained it all back and more....
I worked in nursing (not an RN but a PCT) on a surgical floor for a couple years... as for the insurance part of it well I can't answer that. Some insurances cover some don't. As for the surgery, for someone to get it they have to fit many requirements. A certain BMI, age, certain medical conditions, and they must actively attempt to loose a certain percentage of their body weight before our surgeon will even consider them. By far there are many complications with the surgery, especially the roux en-y. This can create a vitamin and nutrition deficiency in certain patients after surgery. You will ALWAYS have to take iron pills and vitamines and your food intake will be reduced permanantly (as will your sugar intake) as your body will no longer be able to process it's food. If the diet isn't modified then people can stretch that pouch back out and gain the weight back that they loose. Surgically they detach part of your stomach to make the remaining pouch of stomach about the size of a golf ball. After surgery for the first few days you will be allowed only 30ml (an ounce) of liquid or ice chips every hour. Essentially the tiny part of the stomach that is there for you to use is reattached to your small intestine. This is what creates the medical malnutrition, you are bypassing the area where all the vitamines minerals and nutrients are absorbed. Most generally it is done laproscopically, so you will have 4-5 tiny incisions. It causes drastic weightloss, in some cases much faster than medically safe. One of my coworkers had it done and ended up with several strictures (where food couldn't get in the new stomach) and almost ended up on a feeding tube. Some people deal alright with it. You should research what the medical field says about rapid weight loss and how it affects your heart and you should also know that there isn't much information on the long term prognosis of people who have had this surgery. The lap band is at least reversable, although at its worst it can erode the stomach. Weight is lost at a more reasonable pace and there are fewer complications than the other bariatric surgeries. PERSONALLY if I were to ever consider a surgical option for weight loss, it would be a life or death matter. If my Physician said that I needed to make drastic changes or I would die in a year I would consider the Lap Band. I am very overweight but I know that I have the determination to work it off through behavior modification via exercise and my eating habits. I am not willing to take the surgical risks that these surgeries have. Good luck to you and whatever you choose.
BCBS California (and probably others in the BCBS family) covers both Roux-en-Y and LAP-band. But you have greater requirements for the LAP-band. For LAP-band, you need a BMI between 30 and 35 with at least 2 co-morbidities. And they might still say 'no'. If your BMI is 35 or higher, no co-morbidities are required. But for some reason they seem more willing to approve the Roux-en-Y. Maybe because it's been available longer? I've also heard that you may need to be on a supervised diet plan for at least 6 months before they'll give you the nod. That might actually be longer than that. Yeah, pretty freakin' discouraging. The third major type is silastic ring bypass, which does involve stomach stapling. I think this has largely fallen out of favour with the preference towards Roux-en-Y, at least for doing a bypass. I found a site months ago which gave the history of bariatric surgery and the many different techniques which goes back to the 1950's, if memory serves. Quite interesting. Unfortunately, I don't seem to have the link anymore. My wife got the LAP-band in July 2007. She's lost some 45 lbs to date, and is halfway to her current target. (We might change her target as she gets closer to it; it's a pretty artificial number as it is, anyway.) Once there, she'll get her tummy tuck. She's already keen to get that done, but knows she has to be patient. Links below which might help. Do check out videos for the LAP-band procedure on YouTube. If you don't have a strong stomach, you may not want to watch. But if you can detach yourself, they're quite interesting. Virtually no blood, and only one suture needle. Some amazing laparoscopic instruments in use. The one thing which attracted us to the LAP-band is that if at a later date it's determined that it's not working out (or perhaps working too well), it can always be removed. Not that you need to have it removed, mind you. My wife found the fill port to be very noticeable at first, but now she has to poke and prod with her fingers to find it. Also check out Lap Band Talk, the forum link is also below. I should also mention that prices can vary wildly. Our out-of-pocket cost was something like $4200, but we found out later that all the bits and pieces and the hospital stay would have put it over $20k easily. Thank goodness for the insurance, although we're still playing "left hand doesn't know what the right hand is doing" with respect to the insurance company (which clearly approved it) and the hospital which claims the insurance company knows nothing about it. Shop around if you have the option, as $10k-$12k all-in should not be impossible to find. Some folks on the Lap Band Talk decided to go to Mexico to get the work done for a great price. And if there's nothing else that you remember, remember this: DOCUMENT EVERYTHING. Get pre-approvals for everything. Including the sleep study, if the surgeon's office mandates it. EVERYTHING. Make copies of everything, put the originals in a safe place. Never leave the originals with anyone. I had a manager who got pre-approved, got the Roux-en-Y, and his insurance company jerked him around for ages, trying to claim he never got approved. He fought tooth and nail and eventually won. Never assume anything. Document everything. If you pick up the phone to talk to the insurance company, get the person's name, number, write down the date of the conversation, etc. If someone gives you a verbal approval, be sure to get them to send you a hardcopy (after you've written down the approval number yourself, of course). If you don't stay on top of things, they'll pounce on the slightest opportunity. Either that, or they're so steeped in bureaucracy that they really don't know what's going on. Best of luck!