Banded Together

I’m re-posting a question on the blog to the forum because I think it’s a good question that other people may wonder about. In a couple blog posts, anmom asked in reply about insurance predetermination:

“Please—Is there anyone out there who has gotten through the system without 6 months of additional dieting under a physician’s care, even though the insurance has stated this is needed? Don’t they understand how many diets we have been on and how we don’t lose or we gain it back. How many hoops do we have to jump through? I am afraid that I will have something major happen while I am going through 6 more months of what is a stalling tactic.” (http://www.moreoflife.com/blog/blog_entry/five_myths_standing_between_you_and_a_better_life/)

and

“Is there anyone out there who has been allowed surgery before six months, even though the insurance says six months of recent weight loss attempt under a doctor’s care? I have done this multiple times, but none recent. I am not sure what they think an additional 6 months will do for a person—or people (most of us) who have lost and gained throughout our whole lives.” (http://www.moreoflife.com/blog/blog_entry/five_lap-band_myths/)

I’ll open it up to the people in the forum to answer, and I’ve also got some response from some of our insurance specialists, which I will share in the next post.

Andrea, one of our insurance specialists, pointed out that language like this regularly appears on insurance company websites:

“The Lap-Band system is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise, and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives.”

She told me that the insurance companies know the patients can diet and have dieted in the past, and they are not necessarily trying to stall. The insurance companies are paying a lot for an elective surgery and want to insure the patient is going to be compliant.

In addition, to answer your question no there is no way around the supervised weight loss program if that is one of the criteria set forth by the insurance companies.

Thank yu for responding. I am doing as requested, and will not give up. I am definitely committed to following through on the request in order to have the surgery. I guess my frustration is that I took a year to research and make a decision, but had not heard anything about a 6 month supervised diet or would have had that completed. I look forward to all the support from those who have been through surgery and are losing/maintaining! Thanks again!

My husband and daughter just finished the last requirement from our insurance.  I hope everything will be approved soon.  I want the best for my family.  But how long does it take for BCBS of IL approve lap band, since their new requirements?  Does anyone know?