CHECK YOUR PLAN FOR 2013 BENEFIT CHANGES
When an employer group changes, generally their benefits change too. MIMA is now Health First Medical Group-as MIMA employees we did not have coverage for bariatric surgery. AS HFMG employees we do. Chase recently was purchased and also had major benefit changes. That group no longer has bariatric coverage available to them. For 2013, State of Florida employees have coverage thru their United HealthCare Plan, their Aetna HMO plan excludes coverage. We currently have patients that have benefitted from a policy change and some sadly that have missed their opportunity to obtain a band. Most plans are an 8 month process for Lap Band approval- don’t wait too long to start-it may be too late if you do.
Lifeshape has made some significant changes recently. We have eliminated the program fee and lowered the self pay rate of Lap Band. Insured patients are still responsible for any co-pay or co-insurance as with any other surgery. For those that have no insurance coverage for adjustments, we have also decreased this fee. Seminar attendance is still mandatory, however we will now book an office consult prior to seminar attendance to at least start the insurance wheel rolling. We are also working on an online seminar presentation.
My prior article mentioned a case that I was struggling to move through the insurance maze. We hit one hurdle after another with this process; poor documentation from the primary care doctor, a severe allergic reaction from a test required by the insurance. I didn’t think we could even get the case denied. However we did pull it together and submit to the insurance where it was, as expected, denied. This was actually good news at the time-with a denial we could now turn the case over to Lindstrom Obesity Advocacy. They worked their magic as usual. I am very happy to report this patient received a band last month!!
As always, insurance is a constantly evolving process. If you are considering obesity surgery, start asking questions. I’m here to help, don’t be afraid to ask.
Kathy Blair
Insurance Advocate for Lifeshape Advanced Bariatric Center of Florida.
321-725-4500 ext. 7892
Kathy.Blair@mima.com
www.lifeshape.net
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