Why is it that so many insurance companies seem to put up roadblocks to cover weight loss surgery, and specifically the Lap Band surgery?
My personal opinion:
1) You can get away with discriminating against people with obesity.
Can you imagine an insurance provider denying care to someone in a car accident tellling them “You should have been a more careful driver”, or to someone with skin cancer “It’s your fault for getting sunburned as a child” or to someone with advanced breast cancer “It’s your fault for not getting mammograms”? Of course not. But despite being recognized by the medical establishment as a disease, obesity is still viewed by many people in society as something other than a disease.
2) Living in the past by looking at experience with gastric bypass instead of Lap Band.
It’s human nature to be more mindful of negative experiences than positive ones. Many people know of someone who has had horrible complications of gastric bypass surgery, even death. So they equate bariatric surgery with gastric bypass. The reality is that weight loss surgery is much safer now than it has ever been, in large part due to the introduction of the Lap Band procedure.
3) The insurance company doesn’t view you as a long term investment.
Statsitics show that many, if not most people, will switch insurance companies every 2 – 3 years. Therefore from a financial standpoint, many insurance companies have no incentive to spend money on something now that will improve your health in the future, when you might be insured by their competitors. In fact, that would save their competitors money, because you would be healthier and less of an economic burden on your new insurance company.
We all look forward to the day when all insurance providers place the Lap Band surgery on equal footing with other procedures that improve your health.
For general info, view our main page Lap Band Surgery Texas
5. February 2007 at 8:31 pm
Just wondering if you have had success with Federal BCBS insurance yet. Has anyone had surgery that had Fed BCBS and did it pay?
6. February 2007 at 8:52 am
My husband had the surgery Aug 2006. He has BCBS of Alabama. It took about 6 months to get it approved.
6. February 2007 at 11:58 am
Cool site, Dr. H. Thanks for putting the message board on.
6. February 2007 at 8:14 pm
Anonymous,
Federal BC/BS is a sticky point. They said that they while they approve the Band, they won’t provide a pre-authorization or pre-approval for the Band. We are going to do one Federal BCBS patient and make sure they pay for it; that way the patient won’t get stuck with a huge bill. As an example, a few years ago we did a Band for a patient with Arkansas Medicaid when they said they would cover it. After the surgery was done and the charges filed, they refused to pay. The patient did great, an 18 year old boy who lost about 100 pounds, but obviously neither the hospital, nor us surgeons, can afford to do many cases for free.
If Fed BCBS remains true to their word, we will let you know if you have been to the office for an evaluation. If not, send an email to Jamie (jamie@noscales.com) or Betty (bety@nocscales.com) and ask them to put you on a callback list for Fed BCBS.
7. February 2007 at 7:26 am
Insurance companies are not here for our bebefit actually, it is a money making business like any other. They want to make as much interest on their money as possible, so the longer they can stall the process, they are that much ahead. As a business person, I can see how that pays off for them. But as the patient, you have to manage your claims as agressively as possible. Mrs. Betty(God Love Her), cannot do all the work, so please help out as much as possible, make your calls daily to your claims department, get all the paperwork in order ASAP, leave no room for the remark..we need one more thing from you…. and remember, the squeeky wheel gets the oil. Be an agressive insured, after all, you are paying for this coverage, not begging for a handout from them. They basically are employed by you, not you by them. Just my opinion.
13. February 2007 at 9:56 pm
Dr. Hekier have you done your one patient to see if BC/BS is going to pay. Let us know what has happened to date.
14. February 2007 at 8:08 pm
Betty told us that one of the Lap Bands we did today had Federal Blue Cross Blue Shield (Feb 14).
We will file it tomorrow, and hope to get an answer, i.e. get paid, within 45 days. Make sure Jamie has your paperwork and that you have met all other Fed BC/BS requirements, e.g. medical weight loss history, any psych or nutrition requirements etc. Email Jamie to confirm.
15. February 2007 at 9:02 am
Guess I was the first Federal Bc/BS patient. Cause I was banded yesterday 02/14/07. I feel really good. Have a couple of spots that are sore. I have not taken my reflux meds and I am not having any problems with it,(Can’t tell you how good just that one thing makes me feel) Thanks so much to Dr. Hekier and Dr. Keilin.
19. February 2007 at 8:32 am
How many Lap-Band surgeries have Dr. H. and Dr. K. done? Also, how long have you been practicing this Lap-Band procedure?
20. February 2007 at 12:21 pm
We’ve done about 360 at last count over the past 3 years.
The first year started off fairly slowly as people were just starting to learn about the Lap Band.
Now as people have learned about the benefits of the Lap Band and how much safer it is than gastric bypass, we are having more people undergo the surgery.
If you have any questions, call our office and speak with Jamie or Betty.
On http://www.lapbandtalk.com there are threads by our patients for Texarkana Bandsters and Mt. Pleasant Bandsters. Go to USA support, then Texas.
This weekend our bariatric database program was updated and it has a patient forum session but we have not had the training to set it up yet. Stay tuned!
Regards,
Dr Ron Hekier
14. March 2007 at 12:54 pm
I’m an AR-side teacher and found out at the seminar last night that our insurance won’t cover the surgery. Is there a way to find out how many AR teachers in the area are interested in the surgery so that I can mail our represenatives and the governor to see if maybe they can start moving toward a change?
21. March 2007 at 4:00 pm
I am very interested in the Lap Band. I have Health Advantage and AR Medicaid. Just wondering if anyone has had success in getting coverage for the surgery with the same coverage I have.
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10. April 2007 at 11:09 pm
I have BC/BS of Alabama thru Lowe’s. Does anyone know if this insurance will cover Lap Band??
Also, I know someone that is obese and may get put on SSI. Will this insurance cover Lap-Band?
11. April 2007 at 7:31 am
Teachers who are trying to find finance options, members of the NEA can get great LOW APR loans right now through:
http://www.nea.org
I’ve been researching as many loans as I could find for the past two months and found that the NEA loan has a lower APR than the medical loan companies do.
I hope this helps others like me.
15. May 2007 at 2:50 pm
Hi, I called my insurance today, Blue Cross of Arkansas, I am not on a group plan so yours might be different. I was told 1. The Dr. had to get it pre-approved, 2. I have a $1,000.00 deductable I have to pay the 1st $1,000.00, 3. Then they expect to pay about 1/3 of the remainder.
I have another problem, I am 5 feet 2 inches, weight is 226, I have C.O.P.D. can I get the lapband?
13. June 2007 at 10:27 pm
I live in Iowa and I’m thinking about getting this done. Could you suggest a good place and Dr. to talk too? Thanks C.
7. July 2007 at 4:12 pm
Did Federal BC/BS pay yet for the patient that was banded on Feb 14? Have you had any other success with payment from Federal BC/BS? I have Federal BC/BS and was pursuing getting the lapband until I found out my insurance company does not pay, but will pay for the gastric bypass
12. July 2007 at 10:07 pm
Yes,
Federal BC/BS is now paying for the Lap Band if the appropriate pre-op requirements are met.
Call our office and speak to Jamie who specializes in the insurance requirements. 903-794-2263(BAND)
Good luck!
4. August 2008 at 2:12 pm
Anyone with experience with United Health Care? I can’t get them to tell me what pre-op requirements are…
10. August 2008 at 5:12 pm
Call your insurance company and follow the steps on our webpage at
http://www.noscales.com/lap-band-insurance.html
That should work.
28. August 2008 at 6:11 am
I have Federal BCBS, saw a few places on the web where they do not require the 6 months weight loss history. Does anyone have any experience with this?