Wiki Workup for Lap Band Surgery

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sjmccarl52

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When patient was seen for workup for lap band surgery, we used 278.01, V85.41, 327.23, and 401.1 in that order. PA Blue Shield denied the visit because of the diagnoses, I am assuming the primary diagnosis, and says patient is responsible for the visit. My surgeon is not willing to change the order of the diagnoses since obesity is the main reason for the lap band procedure. Has anyone else run into this and, if so, how did you handle it? We are currently in the process of checking with the insurance company to see if they are going to pay the lap band surgery. Our patients are seen in the weight management clinic before scheduled for surgery and the medical diagnosis is used first and then obesity. HELP!!
 
The patient's plan could well have an exclusion for the treatment (including surgery) of obesity; even when it's morbid obesity. If it is a plan exclusion, then the patient is indeed responsible for all charges related, included the work up prior to surgery.

We can't assume that all insurances pay for tx of obesity or that they deny; with most, it is up to the group whether or not they purchase coverage for it.

I would ask the insurance if it is a contract exclusion, in which case the patient is liable, and I would give them a cost estimate ahead of the surgery.

Hope this helps,
 
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