What Health Insurance providers cover Lap Band?

18 posts in this topic

Posted · Report post

Hi Guys

This is the 1st time for me and I am serious about geting Lap Band. I know people who have had the proceedure and its turned there life around and they are extremely positive about the whole proceess. I live in SE Melbourne and would like to know which health insurance providers cover Lap Band. I know they will only cover a ceratin %. Who are they and please give me details like how long do you have to be a member etc?

What is the excess that you pay once insurance pays the clinic. Thank you in advance for your answers!!

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Posted · Report post

I went through MBF, my clinic made sure there was no gap, i paid about $130 a month for 12 months.

You will no doubt pay more as all insurance has increased recently.

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Posted · Report post

Thanks Ms Jess. What plan were you on? When you say there is no gap do you mean they covered the whole amount of surgery cost?

I went through MBF, my clinic made sure there was no gap, i paid about $130 a month for 12 months.

You will no doubt pay more as all insurance has increased recently.

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Posted · Report post

Hi Mattyk,

I am with HCF. I have top hospital and second top extras I pay $85 per month and the waiting period was 12 months. My excess is only $250. I joined 18 months ago at age 50 so didn't get the life time cover discount. I am being banded on the 18th April. I found HCF through i select. I hope this helps.

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Posted · Report post

Hi Mandie Thank you for replying. Sorry for being a dummy, never done this before. What do you mean by excess? Does that mean it covers all costs of surgery after $250? So you only pay the $250 and they pay the rest?

When you have clocked in 12 months I presume you can then proceed to book in for lap band? Do you have to stay with HCF for a period of time after surgery?

All the best for April 18 I am sure it will be the start of a new life, I cant wait

Hi Mattyk,

I am with HCF. I have top hospital and second top extras I pay $85 per month and the waiting period was 12 months. My excess is only $250. I joined 18 months ago at age 50 so didn't get the life time cover discount. I am being banded on the 18th April. I found HCF through i select. I hope this helps.

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Posted · Report post

Hi MattyK,

I am with Medibank Private. I am on the second highest (middle) cover which is $56 a fortnight. Waiting period of 12 months applies. Its worth the wait, trust me! I never found a fund that would waive that.

My costs were:

$2500 Lap Band fee payable two weeks prior to surgery.

$500 Medibank hospital fee payable on admission.

$387 Anethetist fee payable anytime before surgery.

And then the normal cost for seeing the group.

Sports therapist is $70 a session, seen her once before my surgery, once after.

GP at the clinic is bulk billed (see her ofter for fills and problems)

Surgeon - once before surgery $187

Dietician - $110 a pop, once before surgery, once straight after surgery then every three-six months

Psych - $190 a pop! Once before surgery, once after then again at 12 months post op.

You can take your time with these appts so the cost isn't at once. Medibank gives $300 refund for these visits per year otherwise they are out of pocket. Except Surgeon whom Medicare will give you some back.

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Posted · Report post

Hi Mattyk,

I have to pay the $250 myself and HCF will pay the rest. My surgeon charges $4000 which is not covered by HCF I had to pay this 2 weeks prior to surgery. This covers the surgeon fee and also everything post op including all my fills and Dietitian appointments. Once the 12 months is up you can go ahead and book in. You don't have to stay with private health insurance but I would suggest that you do as you never know when you may need it again. I hope this helps and good luck

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Posted · Report post

I'm with HCF too, top hospital cover with a whole stack of other extras. my premium costs $200 a month, but that is for a family of four. you need to call the insurance companies and ask them for the cover that will allow you to do the gastric banding ( i think the code was 30511 from memory but they will be able to let you know). most insurance companies will have a 12 month wait before you are covered. My op was $16,000, HCF and medicare covered most of it, i was out of pocket for $4,950. this covered the op, stay in hospital overnight and all dr appts, physio, dietician, psych, and fills for 12 months. I had to pay the excess of $250 as well when checking into the hospital. you have the option of taking an excess on your insurance premium, which means if you have to stay overnight in hospital, are you willing to pay a bit at the time as well. i originally had an excess of $100 / night on my insurance premium but i opted to increase it to $250 per night to bring my monthly premiums down.

good luck, hope this helps!

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Posted · Report post

Thanks Ms Jess. What plan were you on? When you say there is no gap do you mean they covered the whole amount of surgery cost?

I was on Top Hospital and Top Extras - yep, the clinic made sure that they used whatever people had a no gap thingo for my health fund etc. Their fee was $2200 which included the surgery and 3 Nutrition appts, 6 surgeon appts, Exercise classes after the surgery and before the surgery the consultations.

Oh i didnt pay for any nights in hospital etc, just paid my $2200 to the clinic and my monthly health fund (i had a $0 excess) and wala 12 months later i was banded

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Posted · Report post

I used to work for HBA/MBF (the two are now the same company). I have a nil excess hopsital cover (Hospital Saver) that has restrictions only for hip/knee replacements, and cataract surgery. I pay $70 fortnightly but this includes extras cover.

All health funds will make you wait the 12 months unless you've already served them with another insurance company. Excess is an option to put on your policy which reduces your premiums, but means you pay a certain sum to the hospital upon admission, in addition to any out of pocket charges your surgeon/anaesthetist charges.

Hope this helps :)

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Posted · Report post

Hi, I have recently been banded (first post). I was lucky enough to have mine done throught the public system. Notning out of pocket, the only flaw is that I get no help from the Dietician. So found one that will be abor $120, hopefully then I can get more guidance. Kay

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Posted · Report post

Hi Curves

Thanks for your post. How did you get banded through the public system? Did you have to wait long? Whats is the proceedure?

Hi, I have recently been banded (first post). I was lucky enough to have mine done throught the public system. Notning out of pocket, the only flaw is that I get no help from the Dietician. So found one that will be abor $120, hopefully then I can get more guidance. Kay

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Posted · Report post

Hi MattyK - I am with NIB have top cover.

Out of pocket costs $3400 for all inclusive post operative fills, appointments etc.. surgery/anaethetist/surgeons assistant all inclusive

Hospital excess $250 + $25 incidental fee

Initial consult paid to surgeon $120 (got $70 back)

$89.95 for Barium Swallow - fully paid by Health Insurance/Medicare

$30 pharmacy meds upon discharge from hospital - no claim

Good luck :)

Sarah

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Posted · Report post

The other option is apply to get early release of super funds to cover all or part of the costs for the lap band operation this can take from 10 days to several months.

I had the several month application but just got the ok Yay.

i am thinking of still joining a health fund as with the amount of weight i have to lose i will need a tummy tuck at the end of weight loss. Plus if anything goes wrong i will be insured .

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Posted · Report post

HCF top cover with $250 excess for first hospital visit each year/,

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Posted · Report post

Im with Medibank Private, we are on midlevel cover, so they will cover it.12 month waiting period, im halfway through. I have to pay the gap of $2800 which covers everything including two week supply of optifast and post-op fills. Only thing not covered is any visits to a dietician.

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Posted · Report post

Im with Medibank Private, we are on midlevel cover, so they will cover it.12 month waiting period, im halfway through. I have to pay the gap of $2800 which covers everything including two week supply of optifast and post-op fills. Only thing not covered is any visits to a dietician.

Don't forget, you can get a referral from your doctor for 5 free dietician visits :) its a Medicare initiative like the mental health ones, except for nutrition.

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Posted · Report post

I've got the NIB top cover as well.

Paid $3500 to clinic - covers all future fills and visits (will be bulk-billed), can't claim this on anything.

$25 incidentals fee to hosp

$90 for barium swallow - waiting on payment (think it's all covered)

No hosp excess

12 month waiting period - premiums about $100 a fortnight (no excess and with loading cos I didn't take up insurance until after I was 30)

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