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You should inquire whether
or not your insurance contract includes benefits for the Lap-Band before beginning the required pre-operative work-up.
Though your insurance contract may offer bariatric surgery benefits, it may not include laparoscopic gastric banding.
It is your responsibility to check your specific benefit plan for the terms, conditions, limitations
and exclusions of your coverage. If your insurance does not cover the Lap-Band, you should consider scheduling a
consultation with Dr. Patel to discuss our other available options for weight loss management.
Some of the insurance plans that may not cover laparoscopic gastric banding include but are not limited
to:
- Amerihealth Administrators
- TriCare (Healthnet)
- United
Health Care
- Cigna
- Federal BCBS
- Various Local Unions
Unfortunately, due to AtlantiCare Regional Medical Center not accepting the following
insurance plans, we are not able to process them for laparoscopic gastric banding and they
are:
- Aetna
- Amerigroup
- U.S. Family Health is out of network for AtlantiCare
Regional Medical Center - you must have out of network benefits to qualify.
- Uviversity Health Plans
At this time, our office is
not accepting Medicaid for laparoscopic gastric banding. You should consider changing your insurance if you are interested
in Lap-Band.
If you have United Health Care Harrah's,
you must call the customer service number on the back of your card and tell them you are interested in Lap-Band with
Dr. Samir Patel.
If you have Cigna, you must
call Betty Rice @ 1-215-567-5953, do not make any appointments with our office until you receive a packet from her.
Most insurances will pay for laparoscopic gastric banding, however they have very strict guidelines that must be met
prior to being considered for this procedure. Below you will find an outline of what insurance companies are looking
for when considering candidates for Lap-Band.
For most insurances, you must provide copies of at least 6 months of documented
diet and exercise programs that have been supervised by a professional and you must have attended either or both
of these for a minimum of 3 consecutive months.
For most Horizon products, you should have a minimum
of 5 years of documented past medical history from your primary care physician which shows your weight, height, any medications
prescribed for weight loss, reduced calorie diets or exercise programs enrolled in, and co-morbidities you are being
treated for.
Your medical records must show morbid obesity for a period of 5 years and you must
have been enrolled in a weight loss program for 6 consecutive months to qualify.
If you were or
are a member of Weight Watchers, L.A. Weight Loss, or other comparable weight loss programs, you should also provide
copies of these records to verify your enrollment.
Some insurances require that you enroll in
a multidiciplinary program that will assist you with your weight management. By attending our free support group, you
will meet the multidiciplinary program guideline.
Dr. Patel will order specific pre-operative
testing that you must undergo before being scheduled for the Inamed Lap-Band System. The information packet
will be given to you during your attendance at our monthly seminars. All testing must be completed and copies of all
reports must be submitted for review and approval by Dr. Patel during your final pre-operative visit to our office.
Our office requires that you collect copies of all of the pre-operative testing and have them with you for
your final pre-operative visit with Dr. Patel. The insurance process will take just a few days and you will be contacted
when it is time to schedule your surgery.
Our bariatric coordinator will be glad to assist you with the paperwork
process. If you need to know which of your test results have already been mailed or faxed to our office, she will
be glad to review your chart with you. It is not necessary to call our bariatric coordinator after every test, you may
contact her before your final visit to ensure that we have your reports.
You must have your copies
with you for your final pre-operative visit so that we may obtain a photocopy of any report that is not in your patient chart.
Good Luck to you.