Daisylee1

ANY SUGGESTION OF WHO TO GO TO ? I CAN PUT 3000 DOWN. WHO IS THE LESS EXPENSIVE IN OUR AREA? DONT YOU HAVE TO PAY FOR THE SURGERY CENTER AND ANESTHESIA GUY THO?"

disregard this post!! i did a new one in the insurance section

i just found out my healthplan with UHC thru the AZ state retirement system no longer covers it. but the lad i talked to said to have my doctor send a letter with weight and BMI and things wrong with me. i am 330 pounds and bmi of 49. I have been overweight for many years. i have proof from a doctor supervised program for years that didnt work well and jenny craig too. She said a doctor will look at it and let me know. she said she has seen it overturned many times. i guess just have my primary write a general letter giving all the basic info and then later if they need more stuff.

Should I just send this all in one synopses type letter stating all these things and if they want more detail i would go from there.

Anyone gotten it obverturned??

i CANNOT BELIEVE THIS. i thought untied healthcare covered lap band but not in the case of arizona retirement system. danbg it. i am sobbing. She told me that many times they will overturn the decision if a a doctor looks at it. i am 330 lbs and 49 BMI. i will need 2 knee replacements done if i dont get this help. I have athsma and other issue too. she said to have my doc send it in and also documentation of a diet plan i followed under a doctor and jenny craig. so i have work to do.

?????? are many people successful in these appeals? is it cheap to try to get it done on your own? anybody tell me what else i could send? she said if they need more info they will ask.

I am so upset. i thought my new life wasd ahaead of me

Why did the doctor say no? was the BMi too low? mine is 46. our insurance requires over 40 BMI. do you have to have other stuff wrong with you also or is the weight of 325 and that BMI enough?

Hello i was told by some to see Dr Robin Blackstone in scottsdale. my insurance says the doctor must do surgery at a place that has a center of excellance rating. I am going to guess all the Banner hospitals have that. I also heard about a group of doctors in Tempe. Dr Barrios maybe? I am sure other individual doctors do it also.

In reading thru these forums I see things like endoscopys and colonoscopys. are you telling me you have to go thru all these type of things to get approved? Thats overkill if you ask me. I saw in my insurance descriptions of what to qualify with and they dont mention this huge battery of tests. I can see normal test like blood etc before any surgery. Mine just says must be 100 lbs over. more than 40 BMI. have one or more things wrong with you and proof of dieting. I am going to be pretty annoyed if i have to jump thru hoops to do this.

Sooo, what are all these many tests we have to go thru.?? i dont need a 6 month diet program as i have been on 2 anyway. dont have sleep apnea, see a psych doctor anyway. I can see the need for the normal tests you go thru before any surgery. blood,ekg,etc. Just curious what others have to do? I have greaat insurance thru United Healthcare which is thru my retirement plan as i taught at schools till last year when i turned 50 and was able to take the retirement and qualify for the plan. It has no deductibles even

I dont mind the tests they want to run. i just dont want to wait that 6 monthes and have to go thru another diet etc. I think all the tests you take seem like normal pre op surgical type tests anyway.

Hello all- i did not have time in my prior post to get into much. I am hoping I can skip the pre-qual stuff and get right to it. I am 5'8, 325 pounds, 47 BMI, one knee already torn up from an accident. My surgeon said both knees will need replacing within a few years but will not allow a surgery until the weight has dropped as I will not recover properly. My left foot is a problem and they said i will end up in a wheel chair without fixing it. I have that lymph Fluid in my ankles. i am short of breath and have athsma. Have not blood work yet but it should be not so good I bet. I think even if my blood was normal with all my other issues I should be okay.

Do you think i am a good candidate and am hoping not to have to jump thru too many hoops. I have been overweight for 20 years gradually going up to now.

I have been on jenny Craig twice. Lost 25 pounds the first time 10 years ago, got nowhere last year. i have also been under a doctors care with diet pills etc for many years and its been a yo yo at best.

So wanting opinions. I knowUnited healthcare is good about this surgery. I just am a worrywort. if I cant have it done I'd rather just check out early than face all this stuff later on.

My insurance company recommended my doctor because it had to be a Center of Excellence. I had to pay $5. I got a bill in the mail for $5 from the hospital and I am fine with that because when I added up all of my explanation of benefits, it was well over $28,000. I only went to one seminar and that was for the surgeon that completed my gastric banding. As far as the Tummy Tuck, I can not answer that. I am only 3 months out!

Thats what I thought. you have the same thing as me. It requires that Excellance center. so i will go ahead and just get a doctor referral. i doubt i will have to do any 6 month things or have a wait. i think if a company requires a certain hospital to go to than they should provide the doctors who go there. 28,000 seems very high to me. also I wonder if the insurance will pay more of it if you are critically obese co0mpared to someone who is not.

also i am a little freaked out by hearing about tummy tucks and extra skin being removed from arms. these are all cosmetic and insurance does not pay that. am i going to look ok? i just want to weigh half of what i weigh.

Ask around about surgeons in your area. attend seminars to meet the surgeons. Look online and do the research, just don't pick anyone, ask around.

as for the insurance. everyone's is different. i am fortunate my insurance pays for it 100%, i only had to pay $150 to my surgeon for my consultation fee. that is it.

ask your insurance how much they pay, is it 100 % or 80 %. if you pay cash, mine would have been $16,000 and they actually do financing there too.

hope it all works out for you

Hi thanks for responding. i did find out that the insurance requires that the surgery be done at a place that has the title center of Excellance. several surgeons dont have that. I know of seminars but i did not want to waste much time. Do you think it would be smarter just to get some doctors names that the insurance company recommendds? I noticed last night under my insurance that I can skip the prequalify process as I have mnay of the things needed already.

I have no deductible to meet. it says that you pay the 80/20 thing and the most i would pay would pay out of pocket ever is 3,000. i have that saved up..

mainly i just was thinking instead of going to all these seminars i should go to the right one in the first place. what do u think?

I plan to have lap band surgery soon. i believe my insurance will completely cover it as I have all the requirements and then some. Just curious should I ask my insurance to recommend a doctor or just go to any seminar near me? what was the average outof pocket costs for the surgery? not after care,just like what amount after insurance pays their share? thanks

I also wanted to add that I meet the requirements my insurance has for automatically qualifying for it.