What do insurances actually pay?

[reeciecup]

Hello,

It is always great to hear of approvals for the LAP-BAND. I hope that insurances are turning the corner and realizing the long-term benefit of paying for the band and saving on costs in the future regarding obesity related problems...You would think that it's a no-brainer to the insurance companies, but I think a lot of them are in the mindset of save the money we would have to pay out on claims now and worry about the consequences later...Hopefully, with the approvals I have seen on this site, that is changing...

I was wondering just how much insurances are actually paying for the band...for the facility charges, as well as the anesthesia charges and the surgeon's charge. I wonder if we could all help to compile some information to see what it really costs the insurance companies..we could actually "band" together and make a difference for those who have not been fortunate enough to have been approved...

So, if you are interested, please list the state you are from, your insurance company, and the amount paid from you explanation of benefits for the facility, the anesthesia, and the surgeon...Please don't list your name---I think it will be very interesting to see what the "bottom line" is that the band actually costs the insurance companies!

Thanks!

[Kim G]

It would be hard for people not to list their names if they are in the signature lines. :)

Insurnace companies have contracted rates with each surgeon, hospital and everything else so that is all they are paying. They could pay one surgeon $1500 and another who has a higher contract rate $2500 so really the responses will be all over the place because of those contract rates. I will tell though that as a genreal bariatric surgeons are some of the lowest paid contracts. Sad but true!!!!!

I know this wasn't what you were looking for but I hope it helps some.

[TracyinKS]

Around 25K is what the total cost paid by bcbs for my band and.. but like Kim said their are contracted prices and write offs and all other red tape crap that goes along with it........

Although my company does have a specific Obesity section in their SPD, and it covers revisions, complications and plastics to remove the excess skin as a result of bariatric surgery........ COOL huh? I have found though that finding a plastics surgeon who will work with insurance is another enchilada

[jypassmore]

I submitted my pre-authorization to Aetna, but they denied me due to the clause about "being followed for 6 months on a dr. supervised diet". I felt like I couldn't wait any longer - I was ready - so I self-paid. I can appeal, but is there any reason to after I have already had the surgery? Do you know of anyone who has gotten reimbursed by the insurance company after the surgery has been performed?

[Kim G]

Only if you can prove you had done your 6 month diet or w/ Aetna you can do a 3 month program w/ psych,fitness and nutrition. You could get reimbursed so it wouldn't hurt. But I don't know if you could do the "program" after surgery and get them to approve it.

Good Luck!