I have been toying with the idea of LapBand surgery for about a year. My favorite cousin and I were on the phone comparing our symptoms from being overweight, I'm 5'9", 243 lbs, BMI 35.5l (heel spurs being my only real complaint :wub:) and she said she was going to get banded. Not two months after I spoke to her, she had her appointment and was going in. She had her surgery successfully and I was still hemming and hawwing about me losing it on my own...blah..blah..blah. (gained 15 lbs) Well about 2 months ago she came to visit me and she looked amazing! She and her mother own a restaurant so food is a huge part of her life and when I saw she was able to lose weight it in spite of cooking and being around GREAT tasting food all day, I got inspired, again. I go online, do some research on the procedure, what it entails, doctors, recovery, etc., and I find a doctor, schedule my seminar (this Sunday), I stumble across this site () and YESSSS! I am having LapBand surgery!!!..... What a fool I was being!!! ... First, it never occurred to me that my insurance would have "requirements", it never occurred to me that the doctor I so carefully selected wouldn't accept my insurance, it never occurred to me that I would get totally lost in this process and perhaps not even qualify! After all, I talked to my cousin, she said she was going to do it, did it, lost weight, looks and feels good, and the rest is history. Naturally the process would be as easy for me! NOT! I called my insurance (Aetna Open Access HMO) they point me to the list of "to do's", tell me I need to get an out of network request for the surgeon I have selected from my PCP and if I qualify they will pay 90%. OK, so I make an appointment with my PCP for tomorrow but I really don't know what I am going to see her for (:wink:). I will tell her about my desire for LapBand surgery and take it from there. I don't know if she is the one that should be submitting my paperwork to Aetna or if my surgeons office should do it. But since they don't accept Aetna, I'm thinking they won't do any "leg work" for me until I am approved by Aetna and they are sure they are going to get paid. I don't know... I will see what happens tomorrow and see what I need to do/can do/ or can't do after that. To Be or Not To Be continued....

i'm sorry, but your avatar looks like, "To pee or not to pee..." : )

keep doing the hoops. hopefully it will pay off for you.

best of luck!

Happy- I was approved by Aetna HMO recently. Feel free to send me a message if you have any questions. It is a long road but sometimes you just have to sit back look out the requirements and work out a plan. Good Luck! Linda

Thanks for the comments and you're right, he does look like he's about to let loose any moment! LOL. I thought he was doing the "happy dance" hence my screen name, but now that you mention it... :wink:

Anyway, today was my PCP appointment and I've only been to her once since I switched providers last year. As soon as I mentioned that I needed an "out of network precertification" from her to go see the surgeon I selected, she went in to "dumb" mode... what is that, how do I do that, I can't guarantee that, I've never done that, no patient has ever asked for that... and on and on. Well, I am pissed b/c she didn't even take the time to find out what it was before she decided it was something that was out of her realm and Aetna needed to call her to clarify. Fine. So then I said, what about a sleep apena test? Do you know what that is and how to order one of those? What about a request for medical records from the weight loss centers I have attended? Do you know what those are and how I can get them? (Now she's feeling foolish and like I am questioning her MD ), so she says oh yes, that's no problem I can order the test and I can have my MA fill out the form for your records, matter of fact, do you have a number for Aetna so I can call them now and find out what the precertification is that they are talking about because I've never heard of it. (:wub:). So I give her the information, she leaves out and has her MA make the call to find out how to/what is this precert. I fill out the paperwork for the request of medical records and the sleep apean test and she tells me that her office will call me next week because the 1-800 number at Aetna is giving them the run around. I go home, go to Aetna's website, enter the code for the surgery (43770) and get the link for her to submit my precert online and email it to her. So, here's where I stand as of now.... To Be or Not To Be continued......

Good luck with your insurance. i was banded on Friday the 1st of May and just uncomfortable with the gas.

I also had a severe case of heel spurs also called Plantar Fascitis and was curred 5 years ago with "Extracorporeal Shock Wave Therapy." Check to see if there is a doctor in your area that does it. It was the ONLY thing that helped me. I spent thousands on shoes and medical inserts...nothing worked and cured it but ESWT.

Good Luck