The surgeon's office has heard from my insurance. It is possibly a covered procedure, BUT.....
6 months supervised diet with my doctor, WW or any of those won't count. I asked if the fact that we talk about my weight everytime I see her counted and they didn't think so. Then I have to loose 20 pounds. After that they will "review". So 6 months from now they could still say no.
I was going to call the insurance company today and try to talk to someone that could give me details about how to get approved. Will my past appointments count? If not do my appointments need to be billed with a certain code? Anybody have any thoughts on other questions I should ask?
Then Thursday we have a meeting with our accountant and I'm going to talk to him about the possible tax advantages of self-pay. My estimated cost with ins will be $2500, selfpay cost $15,500. So we'll see ...
BUT a big problem with self-pay.......................... I'm completely totally 100% terrified of failing yet again at loosing weight and spending $15K to do it!! This fear is a big part of what stops me from trying, and yes I realize how stupid that is. My bff has been trying and trying to stop smoking and just can't seem to. But I tell her all the time she hasn't failed until she STOPS trying. As long as you are trying there is hope.
So why don't I listen to me?????? I'm as bad as my kids! lol
oh and tomorrow I'm having lunch with a lady from LBT that lives near me! Can't wait to meet my first "internet person" lol. Remember when something like this was a bad thing? Internet people were scawwy! :) I remember being scared to go in a chat room for the first time 9 years ago!
So we'll see what the insurance peeps have to say tomorrow. I'm not holding out much hope that they will say anything tho, it is insurance after all!
I too had to do the 6 month thing. I didn't have to lose a particular amount of weight, just not gain. The nutritionist should place you on a diet of so many calories per day. I also could not count previous visits with her. The 6 months went by very fast. You can do this, and you will succeed with the band! Be positive girl!!!!
ReplyDeleteBecause I had a lower BMI. 34, my insurance would not cover the procedure. I investigated the possibility of going self-pay but at $16,000, it was just too much money to spend. Instead, I researched this to death and ended up having surgery in Mexica with a fantastic surgeon who worked in Chicaco for a year training American docs on the LapBand procedure when it was approved by the FDA. The total cost, including airfare was $8,000.
ReplyDeleteThe fact that I had to pay out of pocket has been the biggest motivator for me. I do not want to let my family down by spending this money and than ultimately failing to lose weight. This is not an option.
It is a very personal decision and I wish you luck in getting approved by your ins. carrier.
I agree with Jacquie. I was self pay but at a clinic here in Canada. No insurance coverage for any band here. It cost me $16,000 but then someone else got a 10% discount so try to deal with your local clinic. Mine is a tax deduction (medical expenses) and I expect to get 1-2 thousand back. It does give me some extra incentive to lose weight but it is really lifesaving. I may have been on a plateau for 3 months but I am now losing weight again. I wouldn't have been able to do it without the band. Many go to Mexico but make sure you have someone who will do the fills locally. Some docs won't fill patients from Mexico. There is also something called Fill Centers in the US. Good luck on your decision. I think it is the best decision I made and will save my life.
ReplyDeleteMy insurance did not cover surgery at all so I had no choice. I went to Denver, and paid $9900 total. Two doctors in Denver -- Dr. Brown and Dr. Kirchenbaum -- offer this price for self-pay, and both are excellent. I am really happy I did it here in the U.S., but I would consider Mexico too. I say GO FOR IT and spend the money if you can. 100% worth it, and you WILL NOT fail!
ReplyDelete