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Does most ins. co pay for G.B. surgery?


newme4life05
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For anyone who has had G.B. surgery, did your health insurance cover all costs including all the docs appts. and everything in between? If so, what is the steps to start, to find out if your insurance company will approve you and pay for the surgery.

For all the threads I have posted, thanks to everyone who has replied, you all have been so helpful.

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This is my first post. I've been snooping around for about 3 weeks now. I have an appt. with my family Dr. this week to discuss GBS. I'm curretly 38 year old male, 6' 6", 348 lbs. BMI 40+. Aside from sleep apneia my overall health is pretty good (unless you count back pain). I've fought my weight as long as I can remember. I have an 11 year old daughter that I want to see grow-up, and I think GBS will help me lose the weight and KEEP IT OFF.

VanessaSFL you mentioned that you have United Health Care. I also have UHC, I called them ant they said that GBS is covered, my questions for you are "How did the approval process go? Did you have to wait a long time? Were there any special requirements that you had to meet?" Any other insights reguarding the insurance aspect, or any other input you or anyone else has would be helpful.

Thanks Britt

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Hi, guys,

I'm fairly new here too, but I have Blure Cross. First thing was I got a referral to a bariatric surgeon from my pcp. I wrote a letter to the insurance company listing everything I had tried to lose weight over the last 20 years; diets, gyms, anything. Told them all about my back pain, high blood pressure, "fatty" liver, depression, etc. And basically begged them to help me start my life again.

So, I was approved for a consult with our wonderful Dr. Callery. Depending on your doctor and your co-morbidities (problems), you'll need alot of testing. I had: labs, sleep study, ekg, pap, gallbladder ultrasound, psych consult, nutition class, education seminar........I think that's it. :confused:

After everything, report in dictation, and sent to insurance. I've been told, at least with my insurance, if you get approved for the consult, they almost always approve the surgery. My whole process took from October '04 to approval from insurance about 02/15/05, surgery on 03/23/05 ( made me wait longer cause I smoked :o )

Hope that helps. Writing down everything I think helped and my pcp asked for it to send with his referral. Also, my surgeon also wanted the same information for his files.

For fees, I had my $10.00 co-pays for the dr visits, $1500.00 for admission at hospital and I think that's it. Good luck to both of you.

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I am learning about all the steps on how to get GBS. So tell me you have to visit your family doctor first? and what, they have to make a decision if you are up to par for it or not? What if they say no because they don't believe in GBS?

Anyone out there with alliance group (PPO) and blue cross blue shield carefirst (HMO)? and who has had or going to have the surgery and tell me how alliance group and carefirst were with paper work, excepting approval all the steps you need to do to send into ins. co.

Thanks,

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The way I see it you need to have a recomendation from a Dr. to the insurance company, or at least it helps. I honestly don't know what my family Dr. will say when I talk to him this week. I hope he will understand the situation that I'm in and be willing to work with me. Personally I have a hard believing that ANY Dr. would rather have a patient that is Morbidly obease and at risk for countless health problems over a patient that would get GBS and benifit from better health. As I mentioned earlier, this is all new to me and I figured that my family Dr. would be the best place to start.

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A general list of what goes on if you have an HMO.

Get a referral to a bariatric specialist from your PCP (try to get one that has a total program of nutrition counselling, not just a surgeon)

Get a referral to a psychologist from your PCP

Have two to five years (differs amomg ins cos.) worth of medical history released to the surgeon's office

Have six months within the last two years of a medically supervised weight loss attempt

Get a recommendation letter for WLS from your PCP listing co-morbities

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I have UHC, and when I pull up my policy info, it says that WLS isn't covered. But, everyone always tells me how lucky I am to have UHC, so we will see. UHC seems to be approving this for everyone else :)

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I also have United Health Care - from reading the insurance section over on Obesityhelp.com it seems to be hit or miss depending on what plan you have. When I spoke today with a representative I was told as long as it was deemed medically necessary they would cover 100%.

I did read though on Obesityhelp.com that it is an exclusion in a lot of policies and if it is - it appears to be an uphill battle from that point.

All you have to do is call the number on your insurance card and ask a rep if it is included in your particular plan or not.

Sorry I cannot help further about the amount of time it takes to get an answer back - I am going for my consult next week so hopefully I will be finding out how long it takes.

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The way I see it you need to have a recomendation from a Dr. to the insurance company, or at least it helps. I honestly don't know what my family Dr. will say when I talk to him this week. I hope he will understand the situation that I'm in and be willing to work with me. Personally I have a hard believing that ANY Dr. would rather have a patient that is Morbidly obease and at risk for countless health problems over a patient that would get GBS and benifit from better health. As I mentioned earlier, this is all new to me and I figured that my family Dr. would be the best place to start.

Britt~ Yes, the first thing to get is your doctors "buy-in" on the procedure. At first my PCP thought that my choice to do the GBS was drastic. I then cried all the way home and called my husband. My PCP (primary care physician), had seen me yo-yo for years! I didn't understand why she didn't think that it was a good idea to move forward with this.

So with that, I went home and proceeded to write her a letter explaining why I felt so strongly about moving forward with getting a referral to a surgeon. About one week later, I received a letter from my medical group stating they had approved my consultation with Dr. Callery! :D I was extremely excited and know that my doctor reconsidered my decision and really thought about my reasons for wanting to move forward with this.

If you have the slightest resistance from your PCP, don't give up. If you feel strongly about moving forward with GBS, you want to stand up for yourself and fight for your health.

I am 8 months out and feel wonderful! My husband is 5 days out and I look forward to spending the rest of our healthy lives together.

Please let us know how it turns out and WELCOME to the forum!! :rolleyes:

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For anyone who has had G.B. surgery, did your health insurance cover all costs including all the docs appts. and everything in between? If so, what is the steps to start, to find out if your insurance company will approve you and pay for the surgery.

For all the threads I have posted, thanks to everyone who has replied, you all have been so helpful.

Hi NewMe~

All insurances are different. Even if it's the same insurance, every employer has a different plan with different co-pays, etc.

Mine, for example, paid for all of my surgery, except for the $250 copayment I had to make to the hospital. I also have a copay each time I go to my surgeon for pre & post-op stuff. I didn't have any copayments for the lab work, xrays and anything extra they did.

I would definitely do more research in your state and area to find out in particular what your insurance will and will not cover.

Good luck and WELCOME to the forum too!!

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