Healthnet HMO and lap band

[tonysdca]

Has anyone had experience with getting approval of Lap Band from HealthNet of California? I tried for over a year to get approval for Gastric Bypass and they just kept putting up obstacles. The "medically supervised diet program" for 6 months (for which they wouldn't pay! )was the last straw. I have since decided I am more comfortable with pursuing Lap Band and before I go through another year of fighting - I wanted to see if anyone with Healthnet HMO actually got approved.

I know the plans vary by employer, but I work for the Univ. of California - one of their largest customers.

My other option is self-pay through Dr. Martinez in Tijuana. My big concern is if I had complications, would I then have problems getting treatment from HealthNet back in California. (I should probably post that question on a different forum).

I have the classical health problems of obesity (diabetes, hypertension, sleep apnea) and a BMI of 37 so I easily meet diagnostic criteria for morbid obesity. Generallly, I am probably a good candidate for either bypass or lapband. But the barriers to getting health care for this are unbelievable.

Thanks.

Tony in San diego

[marshaj]

Has anyone had experience with getting approval of Lap Band from HealthNet of California? I tried for over a year to get approval for Gastric Bypass and they just kept putting up obstacles. The "medically supervised diet program" for 6 months (for which they wouldn't pay! )was the last straw. I have since decided I am more comfortable with pursuing Lap Band and before I go through another year of fighting - I wanted to see if anyone with Healthnet HMO actually got approved.

I know the plans vary by employer, but I work for the Univ. of California - one of their largest customers.

My other option is self-pay through Dr. Martinez in Tijuana. My big concern is if I had complications, would I then have problems getting treatment from HealthNet back in California. (I should probably post that question on a different forum).

I have the classical health problems of obesity (diabetes, hypertension, sleep apnea) and a BMI of 37 so I easily meet diagnostic criteria for morbid obesity. Generallly, I am probably a good candidate for either bypass or lapband. But the barriers to getting health care for this are unbelievable.

Thanks.

Tony in San diego

I Tony

I have Health Net of Calfornia, they gave me such a run around. They told me I had to see a Dr. for six months and then if I still needed the surgery, I could get it. I was 100 pounds over weight, no high blood pressure, no diabetes or other complications from being over weight, yet. Two months into the 6 months of visits, I received a letter in the mail that said I did not qualify and they would not pay for surgery. Three weeks later I was in Mexico having the surgery. Dr Ortiz is the best, no regrets. Best decision I ever made. Had the best care, the staff is wonderful.

Good luck

Marsha

[MamaMichelle]

If you do end up being self pay there are ways to deduct some or all of your surgery costs on your taxes, that's what I will be doing!