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 Posted: Tue Oct 05, 2010 11:21 am Post subject: Lap-band insurance coverage |
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I find coverage for different surgeries, but I haven't come across any lap-band insurance coverage. Have you guys come across any? Does Medicare cover it?
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Pilgrim30
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| Posted: Wed Oct 06, 2010 10:25 am Post subject: |
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Medicare only covers things that are "medically necessary". Lap band surgery may not always be regarded as medically necessary.
HMOs may not to cover it, PPOs usually do, but again it must generally be medically necessary.
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MaxHerr
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| Posted: Wed Oct 06, 2010 12:46 pm Post subject: |
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| Quote: | | Lap band surgery may not always be regarded as medically necessary. |
Does it mean that it has to medically certified by a doctor? Who don't the HMOs cover it when the PPOs do? Is there any specific reason for it?
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Pilgrim30
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| Posted: Thu Oct 07, 2010 6:46 am Post subject: |
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| Some times the local social service agencies would be able to guide you in this regard. If you search through the govt. listings you'll come across the contact information of such agencies. The hhs.gov website will provide more information on this. |
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roddick
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| Posted: Fri Oct 08, 2010 1:54 am Post subject: |
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I think you should do well by asking insurance companies themselves if you need it that badly.
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goodyphilips
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| Posted: Sat Oct 09, 2010 6:26 am Post subject: |
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| Quote: | | Does it mean that it has to medically certified by a doctor? Who don't the HMOs cover it when the PPOs do? Is there any specific reason for it? |
Yes, to be determined as MEDICALLY NECESSARY requires the certification of a physician. HMOs and PPOs are not required to cover ELECTIVE procedures such as the "lapband" weight loss surgery. HMOs in particular do not go out of their way to offer such procedures to their subscribers, but if a doctor says without a bariatric procedure, the patient will suffer other, more costly adverse effects, even an HMO will probably authorize a procedure.
The "lapband" procedure is mostly a "vanity" surgery, and does not usually produce the dramatic weight loss results other true bariatric surgical procedures do. PPOs typically offer their subscribers certain "liberties" that HMOs do not, but even some PPOs will not authorize a "lapband" procedure.
The "specific reason" for which you are seeking an answer: PROFITS.
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MaxHerr
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| Posted: Mon Feb 07, 2011 2:06 pm Post subject: Greetings, new here! |
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Hey just joining, glad to be here! I'm glad to be here finally, heading to publish considering the fact that I've been studying a prolonged time.
Sooo anyways, plenty about me, see you close to and hello again haha.
BTW, what can I do to change the time zone for my account? It's kind of weird having the time like 5 hours off lol
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MIAJen
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| Posted: Sat Mar 05, 2011 2:07 pm Post subject: |
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| all private health insurance plans only cover treatment that is "medically necessary". |
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FlHealthGuy
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| Posted: Thu Apr 26, 2012 6:33 am Post subject: |
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Yes. As of February 15, 2006, Medicare can now cover the cost of lap-band surgery for qualified patients.
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medix
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| Posted: Sat Apr 28, 2012 11:44 pm Post subject: |
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| Quote: | | qualified patients |
It is not about "qualified patients" it is entirely about MEDICAL NECESSITY. Only a physician can determine this.
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MaxHerr
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