The following are Insurance companies that typically cover Lap-Band surgery:

  1. Blue Cross Blue Shield of Michigan (all except Federal Employee Programs). Many Out-of-Sate BC/BS companies do not cover Lap-Band.
  2. United Health Care
  3. Aetna
  4. Blue Care Network (however they have their own list of facilities that they require their members to use)
  5. M-Care
  6. Some PPOM policies

The following do not cover Lap-Band:

  1. Federal Employee BC/BS
  2. HAP
  3. Some PPOM policies

If you do not see your insurance company listed here; or, if you plan to make an appointment for a consultation, please call your insurance company. Ask them if they approve benefits for Lap-Band surgery (procedure/CPT code 43770 and diagnosis/ICD-9 code 278.01). If they do cover the surgery or say that it is dependent on a “medical necessity letter”, ask them what their medical criteria are.

If you belong to one of these plans, this means that Dr. Deol has agreed to accept their payment for billed services. You would only be responsible for any agreed upon co-payment or deductibles as outlined in your policy. If your insurance company is not listed, you could still see the doctor, however, you would be expected to pay the full amount upfront and submit your claim to your insurance company for reimbursement. It is up to your insurance company to decide how much they would reimburse you. A pre-certification letter would be obtained from your company prior to surgery which would outline this for you.

Unfortunately, we have no control over your insurance company or their policies. In the end, it will be your responsibility to know what your personal policy states and weather or not they will cover your surgery. If you have BC/BS, look closely at your card, make sure it says “Michigan” on the card, and get as much information as you can prior to your appointment. We will happily assist you once you get this initial information. If you find that your insurance company does not cover Lap-Band, or that you do not meet your insurance company's criteria, there are companies who can finance your surgery for as little as $300.00 a month. Our office will be happy to refer you to some of these sources. Please call us anytime at (586) 737-2810.

Financial Process
After insurance pays the hospitals and all the doctors, a certain percentage of the bill must be paid by you. This is determined by your insurance company and employer or other insurance source. Generally, the physician's offices, and hospital request advance payment of the "co-pay" by you. Discuss that with them when the time comes to do so. If you need assistance you may request a hospital representative to help you communicate with your insurance representatives and the physician's office, to help you make arrangements.

The cost to you is what your employer [or other group] and insurance company have determined must be paid by you -- the "co-pay" or "deductible" or "per admit fee", or "out of network penalty". It is governed by rules of the particular insurance company. It is necessary to contact your insurance company or companies to determine the "rules", and how they apply to you and payment for the surgery and care you choose.

The Appeals Process
If your initial request for pre-authorization is not approved, insurers provide an appeal process that allows you to address specific reasons for denying your request. It is important that you reply quickly. It is also recommended that you enlist the help of an experienced insurance advocate.

 

Congratulations on taking the first step towards a healthier life!