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Weight Loss Surgery If you've had it, or are considering it, share your discussions here

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Old 02-03-2003, 03:51 PM   #1
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Join Date: Feb 2003
Location: calif
Posts: 7

Question How do you know if your insurance will pay for the procedure

my husband and I both carry insurance, he has a PPO and I have a HMO. How can i find out if they will cover this procedure? do you have to be at medical risk? I need to do something to get healthy and have thought about this for sometime now. PLease if anyone can give me some information I would appreciate it.
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Old 02-03-2003, 05:32 PM   #2
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Join Date: Apr 2000
Location: northern New Jersey
Posts: 7,522


hi michelle!

this isn't an easy decision to make, and it's not a quick fix, so be sure to do your research.

the simplest way to find out if your insurance covers the procedure is to call them and ask. but there are always some requirements that have to be met. first, you have to have a BMI of at least 40, which translates to being about 100 pounds overweight. you can also qualify if you are about 80 pounds overweight IF you have certain medical conditions, such as diabetes, hypertension, and sleep apnea.

and if you have any of these conditions, and are 100 pounds or more overweight, your case is stronger.

a warning: many insurance companies are now requiring 6 months of a physician-supervised weight loss plan. this can be a range of things, so check with your insurance company for the details on exactly what they require. many of us have already had this long history, so it wasn't a big deal. others, however, have fought the battle on their own or have completely avoided doctors.

oh. and some carriers won't touch the lap band, but will cover the rny and duodenal switch...

good luck and keep posting!
Start your day with a smile, and get it over with.
Keeping it off is a hundred decisions a day that help you maintain what you achieved. And that's the hard part. - L Sanders

start: 506 [Sept 2001]
weight at gastric bypass [Jan 29, 2002]: 409
current weight: 225
weight for plastic surgery: 200
final goal: 180

Posts by members, moderators and admins are not medical advice. See your physician before taking advice found on the internet.
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Old 02-03-2003, 06:53 PM   #3
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Location: Snellville, Ga (suburb of Atlanta)
Posts: 1,113


Hi Michelle, wanted to welcome you.

Let us know what you find out.

From 360 pounds, to my first organized 5K (Sept. 20, 03)
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