What were the previous BCBS requirements for lap-band surgery coverage?

Depending on your policy, the requirements for approval may vary. Nevertheless, if your policy covers the treatment of morbid obesity, your insurance provider will most likely ask you to submit documentation for six months of a medically supervised diet and psychological evaluation in order to qualify. What this usually meant for our DayOne Health patients was that they had to meet with our dietitian and get weighted every month for six months prior to their procedure. With the new requirement in place, the length of time that the patient has to wait to get their band will shorten considerably.

What will be the new requirements?

Again, BCBS requirements for the approval of lap-band surgery may vary depending on your policy. However, most of the insurance companies, including BCBS, hold similar standards when it comes to approving bariatric procedures. The first requirement that is always in place when considering whether someone qualifies for coverage is a body mass index (BMI). For most insurance companies, including BCBS, the minimum BMI for approval is a BMI of 35 and above paired with two health conditions related to your weight, or a BMI of 40 and above with no additional requirements in terms of co-morbidities. Insurance companies also require a letter of medical necessity from the weight loss surgeon, as well as evaluations from a bariatric dietitian and psychologist.

How long on average does it take to get all the documentation needed?

With the BCBS changing its requirements, you will be able to obtain all the documentation needed for surgery approval within one to two days. At DayOne Health, you will be able to get most of your documentation ready during your first consultation with a surgeon. While the psychologist is not available here on site, DayOne Health is closely working with two psychologists that have their offices just a few blocks from our main office. In other words, with proper planning you’ll get everything you need to start the insurance approval process in one day. Following the submission of all documentation, it usually takes up to 30 days to hear whether the surgery was approved or not. At DayOne Health we try to make the whole process as easy as possible for our patients by taking care of most of the groundwork. However, if you have any questions considering your policy, coverage, approval, or appeal process, you can contact our insurance coordinator any time and discuss the best strategy.

If you have any questions considering our DayOne Health lap-band program or would like to speak to our insurance coordinator about your coverage call our Chicago clinic at (312) 239-3838.

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You already did your research, chose the weight loss program, and booked your consultation, and now your weight loss team will help you to determine whether you are a good candidate for the lap-band procedure. In order to do that, we at DayOne Health will need to learn about your eating habits, BMI, medical history, and previous weight loss efforts. If you wish to use your insurance to pay for the procedure, we will also need your insurance information.

Do I need to prepare any documentation before coming to consultation?

At DayOne Health we ask our patients to bring only a photo id and a copy of their insurance card. Once you come to your appointment, the doctor will talk to you about your overall health, medications, and any past surgeries. Your medical history is important to us, and during your first visit the doctor will let you know whether you need any supplemental tests. Most often, a bariatric surgeon will ask for additional testing such as sleep study, or chest x-ray if he suspects that a patient has some undiagnosed condition that may interfere with the surgery. Some of the additional testing such as blood work can be done at DayOne Health. Also, you don’t have to worry about checking your insurance policy. Once we have your insurance information, our insurance coordinator will be able to verify whether you have bariatric coverage or not.

How to do your initial insurance verification

If you are not sure if your insurance policy covers a lap-band procedure, and you would like to know before visiting the clinic, you can do an initial insurance verification yourself. To get the information regarding your policy, you will need to call the number on the back of your card. However, before doing that you will need to know your height, weight, BMI, diet, and whether your medical history is significant for any weight associated conditions. Once you have all of that information, talk to the representative and ask whether your policy covers bariatric surgery. If the answer is yes, you can ask whether it covers the adjustable gastric band procedure specifically. Finally, ask whether you can choose any doctor to do the procedure or whether there are any surgeon restrictions. If you would like to read more on how to do your own initial insurance verification, you are more than welcome to visit our insurance page for more detailed instructions. Regardless, remember that we’re here for you, and that we are here to help you make those initial steps.

What is the next step after the consultation?

Depending on whether you decide to pay for your weight loss procedure out of your own pocket or if you can have your insurance pay for it, there might be different steps that you will need to take after your first visit. For instance, while some insurance companies do not require anything more than your height, weight, and medical history to cover the lap-band procedure, some policies may want you to go through a six month diet program and undergo a psychological evaluation prior to approving you for the lap-band procedure. Also, if your lap-band surgeon asks you to do some additional testing, you will either have to have them done at the weight loss clinic, or make appointments in another facility.

Having said that, if your policy doesn’t require any additional documentation or you decide to go the self-pay route, and you have no medical conditions that require testing, your next step is to schedule your preoperative visit.

If you would like to hear more about the lap-band procedure or a DayOne Health weight loss program, contact our Chicago clinic at 312-239-3838 or e-mail at pcc-chicago@dayonehealth.com. To speak with a bariatric surgeon, schedule your one-on-one consultation.

Lap-band insurance coverage

So, to start off– you have health insurance and you would like your lap-band cost to be covered by it. First thing to do here would be to check whether your policy has weight loss surgery coverage. You can check that yourself by calling the number on the back of your health insurance card, or have the insurance person in the lap-band clinic of your choice do that. If you would like to do the initial verification yourself, you can visit our insurance page for instructions. Once you have determined your benefits, you will also know approximately how much (if anything) you will have to pay out of your pocket. The expenses associated with the weight loss surgery, depending on your insurance, may include a deductible, co-insurance, and/or co-pay. If all of that seems like a different language to you and doesn’t make sense, you can always ask a bariatric insurance coordinator to explain and break it down for you.

Lap-band self pay option

If you don’t have insurance, or it does not cover the lap-band surgery, the remaining option is for you to pay for it out of pocket. Once it comes down to this, the first question is whether to have the surgery in a hospital or an outpatient surgery center. Fortunately, unlike gastric bypass patients, lap-band patients have a choice here. The cost difference between having your lap-band at the outpatient facility and at a hospital in respect to pricing is enormous. While at the surgery center your lap-band surgery may cost anything between $13,000-$20,000 (in Chicago area), the hospital, if they happen to offer the self-pay option, will charge you more and most likely keep you overnight for observation. If you decide on the outpatient facility we strongly advise you to shop around. Compare the pricing, and choose your best option in terms of the pricing, quality of care, and support program. Finally, if you have financial hardship but you would like to still consider a self-pay option for getting the lap-band procedure, search for the clinics and weight loss programs that can offer you some financing options.

Lap-band in… Mexico?

Medical tourism has become increasingly popular. Every year thousands of American’s go to countries such as Mexico or India to search for bargains on medical treatments. While many of the foreign facilities don’t differ much from those in America in standard of care, you need to be aware that despite a tempting surgery price, the overall cost may not be much lower than the price given by the surgery centers in America. Remember, if you decide to have your surgery done outside of U.S. please do extensive research first. Ask questions regarding staff and surgeon’s credentials, training, and experience. Also learn as much as you can about the facility where you’ll be undergoing the procedure. The downside of having weight loss surgery in Mexico is that if anything goes wrong you cannot sue, or have any way of exercising your rights as a patient. If you decide to get your lap-band done in Mexico, you also have to make sure you will have a place taking care of your follow up visits, and handling your adjustments after coming back to the States. You also need to be prepared that many clinics and weight loss surgeons charge more for adjusting the lap-bands put in outside of the U.S.

If you have any questions about the lap-band cost or would like to sign up for a one-on-one consultation with a weight loss surgeon you can call us to speak with our patient advocate at 312-239-3838 or sign up on our website. Upon your first visit in a DayOne Health weight loss program we’ll also verify your insurance and let you know whether you are eligible for any financing options if needed.

Most insurances are now offering coverage for the Lap-Band surgery.

At one time it was considered more of an elective surgery; however more and more insurances are now treating Lap-Band surgery as a “medical necessity.”

When working with your insurance they will require proof of medical necessity. What this means is that they have set up a criteria that outlines what would make surgery medically necessary for you.

In order for Lap-Band to be considered medically necessary, most insurances require that you have a body mass index (BMI) of 40 or greater. They may still consider you for surgery with a body mass index of 35-39, but you would have to prove that you have at least two co-morbidities.

Your body mass index in measured by factoring your height against your weight. You can check your BMI using our BMI calculator.

What are co-morbidities?

Co-morbidities are diseases tied directly to the patient’s obesity such as diabetes, hypertension, high cholesterol, sleep apnea, coronary issues, and pulmonary issues to name some. You will notice these diseases can be considered “life threatening.”

Nearly 96% of the insurances that I have worked with require that the patient complete a “medically supervised diet”. The length of the diet depends on the insurance company, but it can be anywhere from 3-6 months in duration.

One of the most common questions that I am asked in regards to this diet is “what if I lose a lot of weight during this required diet”? In answer to this question; insurance companies will factor in your weight taken at your initial consultation. This is the actual documentation that will be submitted to your insurance company for review.

Another thing to consider is this: if you could lose enough weight to no longer be considered at least obese if not morbidly obese in three to six months, you probably would not be considering the Lap-Band surgery. I have yet to see a patient fall off of the “insurance measure” of medically necessary on the required medically supervised diets.

Ninety-nine percent of the insurances I have worked with also require a psychological evaluation and clearance as well.

Some insurance require 3-5 years of documented weight history from a physician.
You can obtain these records by requesting progress notes from your primary care physician or in the case of female patients your gynecologist as either of these should have taken your vital signs which include weight.
Keep in mind if you are trying to use records from you OB/GYN you can not use records that note your weight during pregnancy.

A good way to begin the process of finding out whether or not your insurance covers the Lap Band Surgery is to call the customer service phone number listed on the back of your medical insurance card and ask the representative if you have coverage for “the surgical treatment of morbid obesity”. They will tell you if it is a complete exclusion on your policy or if you have coverage after providing proof of medical necessity.

Once you know that you have coverage just call us here at DayOne Health and set up your initial consultation. You can also request a one-on-one consultation through our website. If you would like to hear more information about insurance coverage of the Lap-Band procedure, call me at 312-255-1900.

Call us today. This could be DayOne of a healthier you. We are waiting to hear from you.

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On Saturday, July 24th, NBC is having a casting for 11th season of The Biggest Loser in Chicago. Organizers are expecting to see at least 500 applicants, so if you’re planning to take part in the event, be there early. The auditions are going to start at 10 A.M. and end at 6 P.M. If you have a lot of weight to lose and don’t mind winning a quarter million dollars, come and join us at NBC Towers in Chicago!

Yeah, the DayOne Health team will be there. Not only to cheer the applicants, but also to give away free cold water. Forecasts say it’s going to be 90 degrees, so prepare yourself to fight the heat. For us, The Biggest Loser is not only a chance to hang out in the fresh air, but also to talk about the lap-band surgery. For the past two weeks we’ve been preparing for this event and now we are ready to join the crowds. Since NBC is choosing only five finalists, we decided to show the other 495 contestants that even if they don’t become the Biggest Loser, they shouldn’t give up on losing weight. Also, for all of those who are not ready to go into weight loss boot camp, the lap-band may be a great solution. Maybe getting a lap-band doesn’t seem as appealing and spectacular as shedding pounds on NBC, but after all, the lap-band equally if not more effective. We won’t promise that you will lose 60 pounds in 4 months, but we are pretty sure that with the right attitude you can easily lose 60 pounds or more in a year. Pretty good deal, isn’t it?

Besides cold water and tons of positive energy, we decided that this special occasion requires something more. We were thinking about another way we could help, and we came up with an idea of a contest. The Lap-Band Give-Away Contest, to be more specific. The rules are very easy. Everyone who wants to win a free lap-band simply has to write an essay specifying why they should be chosen to get the band. If you would like to participate, please write to us about yourself in up to 500 words and paste it into the special box on our sign up page. Right after your submission, our patient advocate will contact you and give some more details about the contest as well as the lap-band surgery. You can submit your applications and essays from July 23rd to October 31st. If you are taking part in the Biggest Loser casting tomorrow, we wish you the best and good luck.

We would really love to hear your story, so don’t hesitate and enter to win a FREE Lap-Band!

You hear a lot about the medical tourism these days. Since DayOne Health is a bariatric clinic we get many questions about getting a LAP-BAND in Mexico. When we ask our patients why they would even considered doing it, they say that it’s the price.  For many who don’t have insurance coverage or who have BMI below 35, self-pay is the option.  Imagine you have a choice between paying $5,000 or $13,000, which would you choose?

Don’t answer this question yet! There may be more to it than it seems…

Remember, if it’s too good to be true, it probably is!  Prices for LAP-BAND surgery in Mexico can actually range from $4,500 to $15,000 depending on the surgeon and facility.  Considering that you would want to be safe and undergo your surgery without complications, you would need to look for an experienced surgeon.  Experienced surgeons in Mexico will charge between $9,000 and $11,000.  Once you reach the $9,000 range you’re basically the same as you would pay in the U.S. plus the travel costs!

Remember that the background check on the facility is as important as on your surgeon. You need to make sure that the staff speaks English and is able to provide you with necessary care in the event of any complications. If you decide to have weight loss surgery in a hospital, make sure that it has an intensive care unit that can handle a bariatric patient. Both your surgeon and facility should meet or exceed American standards. Never compromise your health to save a couple bucks!

Besides phone calls with questions, we at DayOne Health have extensive experience with patients from Mexico. Remember that the LAP-BAND surgery is just the beginning of the journey. Follow-up appointments and band fills are what determine weight loss. In other words, when you decide to get a band abroad, it is a good idea to first find a local clinic that will do your adjustments once you’re back home. I must warn you though… some places charge more for LAP-BAND adjustments when the bands placed abroad. The reason for higher pricing is related to complications arising more often among patients banded in Mexico.

Band erosions, slippages, flipped ports… we’ve seen it all!

After adding travel costs, hospital costs, expensive band fills and a fair amount stress, it seems better to consider surgery in the U.S. Here, you can be sure that your doctor meets all standards and will guide you through your weight loss journey. If you are considering having your LAP-BAND surgery done in Mexico, contact us first. Maybe we can help you find a better, safer solution. Call the patient advocate at DayOne Health in Chicago at 312.291.7501 to talk about the cost of LAP-BAND surgery today!

LAP-BAND procedures have never been more affordable! With DayOne Health, you can make affordable monthly payments on your weight loss surgery. DayOne Health has a partnership that allows weight loss surgery patients make low monthly payments that will fit into any budget.

Your LAP-BAND procedure could be as affordable as $356 per month. At DayOne Health in Chicago, we offer patient financing for Lap-Band surgery making this procedure affordable for any and all self-pay patients. DayOne Health has teamed up with CareCredit, which allows a patient to start treatment immediately with an option to pay in low minimum monthly payments over time.

In addition, insurance companies are also starting to cover more of the cost of LAP-BAND surgery because studies have proved that bariatric surgery is effective in curing ailments due to obesity. On average, insurance companies are now covering anywhere from 60-100% of the cost associated with LAP-BAND surgery.

Keep in mind that patients find that bariatric surgery ends up paying for itself after two years due to the fact that weight loss surgery may help improve and/or resolve conditions associated with obesity, such as diabetes and high cholesterol. Because of this, patients with high blood pressure and other conditions can cut down on cost of prescription drugs, as well as doctor and hospital visits. The positive results from LAP-BAND surgery demonstrate the effectiveness it has had on people’s bodies as well as pockets. Patients are finding it easier to place themselves in the job market due to higher self-confidence and facing less discrimination in the work place.

Contact DayOne Health today and talk to a team member today to find out if our affordable financing is right for you. Lap-Band procedures are now more affordable than ever which means it’s never been easier to achieve your weight loss goals and gain the confidence you deserve. Become the person you want to be at DayOne Health bariatric surgery center of excellence in Chicago. We look forward to hearing from you and we can’t wait to help you meet your weight loss goals. Sign up today to meet with a DayOne Health Professional!