lizrbit

i got notified via my pcp that my insurance has denied my first claim. i didnt have all my records there when submitting the first try so i knew that it wasnt likely. I havent even met with the surgeon yet. Ive met him at the seminar but my first appointment in his office is Monday (feb 5). I was told their office handles all insurance stuff, so im hoping im just ahead of the game and that the game isnt closed yet. After what I posted here last, I had to come back here and post this experience. im not giving up yet. Im going to wait and read why it was denied, im going to talk to the surgeons office about it, and go from there. i'm a little bummed by it, i gotta tell ya...but im not giving up yet.

Hello! well i started a new thread as suggested, but no one has responded, and im still mostly afoot. If anyone would like to meet in galveston, please let me know!!

Yep Nursey, my insurance said the same thing regarding bmi. Ive lost 17 lbs since i left maine to do this, and it hasnt been easy. One of the reasons i want to have it down here is JUST for the reasons you posted. Where i live it is still a very new surgery. They have a doctor in Portland who does them, but he hasnt done anywhere near the ones this one has. I am hopeful. I do hear you about full coverage and the difference. I'll keep my eyes and ears open.

Nursie, i dream of losing one hundred, of what thats like and the possibility of KEEPING it off this time. outstanding. You guys are so supportive. Im glad i found you. im still trying to get approved. I keep hearing this voice in the back of my head trying to prepare me for the fact that my insurance likely wont do an out of network referral...but today i got a deal from my pcp and his nurse saying she faxed the requested letter to my physician as well as to the insurance!!! Its possible this might happen! Im back on the book! im just about done with all my tests. Im trying to be patient, im trying to eat smaller portions so that ill be ready for the liquid diet (which i already have been told the surgeon will make anyone over three hundred do) and i know...so...tomorrow i do the sleep test, and i see the surgeon Feb 5. im trying to be ready. i want this so very much. Im ready!

dont give up. Its your insurance, that you pay each month for. dont give up at least not without some answers. and then dont give up, most surgeons have self pay financial options. (see how easy i said that? if my insurance doesnt approve i dont think i can qualify for self pay due to my current finances...but i definately have to try) call them back, sometimes they can assign you a 'case manager' (free with your insurance) and their job is to get it all in one unified order, and be the person who can answer questions. I do know that you start with your primary care physician. Get his/her support first, then they are to submit a letter of referral describing 'medical necessity' to your insurance. Im nervous about a possible wait. ive done alot of the work already and im ready to go! Good Luck to you (and to me too).

yeah i'm confused in a big way too. Anyone have any information about this? im going to ask my surgeon about this to. I am certain he said "LIFE". maybe the early bands were made of different materials?

my extended family is the least supportive and least nurturing environment one can imagine. Even if they found out, with a picture of me in surgery smiling and holding up a card with my name on it, id deny it. Its none of their business. my immediate family however is all over it. My husband is supportive, my three sons are very supportive (one has wieght issues in the same pattern as i did at his age) and Ive told my best friend of ten years. Since im having my surgery so far away from my family, she (bf) is coming to help drive me back from surgery and take care of me for two days. I love everything Jack writes by the way. What a GREAT perspective hes got and i wish i knew him in real life. I think, that if someone came to me that was obese and i thought the information would help them, and i could trust them, then yeah i dont think id have a problem talking to them about it....but joe schmoe is on a "dont need to know" status.

Hi! Im going through the process too, and waiting for insurance approval. Im Anthem BCBS of Maine, and it looks GOOD so far. Ive heard mixed things in terms of what insurance will expect, what the surgeon will expect, and im also going through all the recommended tests to be ready. Ive met my surgeon already at consultation meeting, and im to go back to see his internist and do the first surgeon date on Feb 5. If my ducks are all lined up he said its likely they will schedule my date then. so far everything has gone very smooth. I still have the sleep study to do, but everything else is done. Most of it was pleasant. I called my insurance a few times. I requested a case manager to help organize everything and make a contact person to give straight answers too, it helps them, helps me too. Im HOPEFUL. very hopeful.

I thought id dotted all my eyes and crossed all my t's before i came down to do this but ...theres always more to a thing. I got a copy of my insurance guidelines and its all good, if anything im a little too heavy for their approval, but if i can just keep off the nervous weight i lost coming down, ill be okay. HOWEVER... having trouble getting my old medical records that reflect over three years total of medically supervised wieght loss, which is required by my insurance (six months is anyway)... so the good news is i'll likely be approved, the bad news is probably not until i can go another six months with pills diet and back to curves again. I hope theres enough in my current records to satisfy this. I want to be banded so much. I want to start this. Today it hit me that it might not happen before i got to go home. Im trying not to think this way, to keep hopeful. Things are going well. I asked my insurance for a case manager to help facilitate this, and to keep everything straight. They said they would, and that the person would be contacting me. so, i guess im just ranting. Nervous. three different 'groups' or organizations involved with this, and im losing direction.

Man thats awesome! see? this is productive already! I try to get into portland for first friday artwalks as often as possible, i can just move it to the second fri no problem!

its so great to talk to other people in maine about the band. I went to the houston seminar and it answered a lot of questions. Today was the psych eval, which was alot of fun (i passed i think) I got a chance to talk in person to Dr St Laurent about the situation and as it stands, im to fly back every other month, and do the other every other month via online, keeping close track of things, reporting them back, and he also said that we experience more weightloss and better success by joining band support groups! (which in maine, i guess thats us, but i do LOVE this board too) I really like him, he seemed very invested. Hes done a kajillion of them too and thats the reason i chose to come down here to pursue surgery with him. as far as flying out every other month, im thinking that will be possible if i buy my tickets way in advance, and do it like an overnight or one day thing. The majority of the visits are in the first year. he said the second year is usually not as intense, but that its different for each person.

man puddin, you really are an inspiration. the Pics are phenomenal and encouraging! I cried when i read this last post. Im pre band...and i cant wait to remember what it was i enjoyed doing. The excitement you have, the energy and the way you described it, i could almost remember doing similar stuff, at least being able to ride a bike outside! I cant remember the last time i did it. Its one of those things where if i KNEW it was going to be the last time, i would have stayed on it longer!!! Congratulations girl, you really truely have earned it, and rediscovered your life it sounds like...

congratulations Joe!!! im excited for you! its wonderful to hear how its going from day ONE!!! please post more when you can as you feel up to it.

congratulations puddin! man i cant wait to see the results! its inspiring!

i weighed 320 when i rolled over one morning and herniated a disc in my neck, rupturing it and needing immediate surgery. that was my wake up call. My dad and his twin brother both died from obesity related factors within nine days of each other in 2005. they were just under six hundred lbs by best estimate and last wieghts. At my first consult i wieghed in at 317, but i dont know if its right, it doesnt feel ike ive lost any. Im in the early stages of the process. my consult was last friday. I had my ekg then, today i had my bloodwork, tomorrow i do the seminar, day after i meet with psych for eval, then nutritionist next day...then wait.... I live in Maine but came down for three months to escape winter and to be banded by doctors that have experience. My bmi was 53 when i got on the plane. There are things i cant do anymore that i just want to be able to do again. There is a life i was supposed to live that i physically cant at this size. I already have an artificial ankle, and it cant take much walking at all. there are other personal issues that im sure you guys probably can relate to too. Im waiting. I am hoping. I have to leave March 21rst.

theres a rumor that there are other bandsters in the galveston area? if so, Im here too, until March 21rst. is there anyone out there?

hey! thank you everyone for your help. i was leaning towards going into a church and begging someone to help me out, when i thought, "i am just going to call and ask". My best friend lives in central oklahoma. I called and dumped it all on her and asked her if she would come down. not only is she coming, but its going to be WONDERFUL to have her with me for this. woohoo! (shes driving all the way down for this, from Central Ok to Houston, and Galveston) !!!

hey im from maine. Im in Houston doing this though. Its warmer down here and i usually run away down here for the winters. I have a three month job which allows me to stay, but i live in maine. Im waiting on a banding date, but i have all my appointments this next week. I found that the stats and referrals that came from Houston were just so much more than in Maine. Im a little worried about how complicated ive made getting fills, but maybe we can network and help each other in the fact finding aspect. Ive done the consultation, the ekg, the bloodwork, tomorrow i do the seminar, the day after i do the psych eval, a few days later i do the nutritionalist eval, and then on the 30th of this month I go in for a sleep apnea test. (whew) still, it was in the high fifties today down here while my people up north maine (im from the county) were in snow conditions. Hows your weather?

Hi! Its nice to meet you! It really is! I went through the first consult with the American Institute of Gastric Banding where they took an EKG and a basic physical, and I have the referrals to the Psych eval, the nutritionalist, the sleep apnea test, and the bloodwork. Im a little confused as to what to do next. Tomorrow is Monday and Im planning on spending the morning on the phone with everyone making appointments. One call is supposed to be to his office to set up the meeting with him. Im hoping this week will be productive.

hey! im in galveston!!! i need support! im not from here, but came here to work, to get away from the snow, and to be banded in houston. I usually rent a car for the day to get back n forth to appointments. any chance of you folks getting enticed to come down here for a meeting?

anyone else here go through these folks? Listen, it isnt a case of "if you cant say anything good dont say anything at all" its a case of "this person is going to squirrell around with my innards and if anyone else has gone through him or these folks, please post your experiences?

hey guys thanks for the feedback. Talking to a social worker might not be a bad idea. Im still leaning towards a cab too. Im wondering about how incapacitated ill be, and a little nervous, but i think it will be okay.

i was told that even though its "outpatient" surgery and you usually dont stay overnight, that i could not drive back to my house (40 miles away). Im concerned about what to do. I dont have any friends or family to help out. I thought about setting up a taxi to take me home, and while it could be very expensive, it would at least solve the problem. Anyone do this? or have experience with how to do this? what are some of the issues you ran into? How did you solve them?

Im going through Dr St Laurent in Houston (surgeon) and through Lap band solutions. (www.lapbandsolutions.com) things look good so far!

i also found that since arriving in Houston from Maine, Id lost fifteen lbs. (i cook alot at home here and havent really eaten out very much) woohoo!