kari_berry

Thanks so much hagerteresa

Thanks for the replies once again. I have yet to make a doctors appointment - but I have it written down at work so I cannot forget. I've been so busy at work (which is where I'm at now) that I don't have much time for anything else...lol. I cannot wait to get the ball rolling on this. Atleast I'll have a start. I will definatly bring paperwork and brochures for the band, and I will also approach my Dr. about it. The worst they he/she can say is no...right? And then it's off to a new doctor. I've decided first to go back to my old doctor's office (where my medical records are) instead of going to this guy that I've only seen once. Atleast at the other place, they will know my history, and I won't have to waste time trying to get medical records from them. I was also thinking about getting my childhood medical records (from another doctor - if they have them). I don't know if that helps any - but it shows weight loss attempts when I was younger, and my weight, ect... I suppose anything that will help. Anyways - I have to get going and finish up some work. Thanks for replying to all my questions / concerns. It really means a lot to me! Thanks again! ~ Kari ~

Thanks for the replies I am going to print out some information on the band from the Inamed website to bring to my PCP. I think first I am going to approach the subject of weight loss medication with my PCP. I've been reading that a lot of insurance companies want you to try other supervised means of weight loss for 6 months before they approve surgery. So if the doctor can put me on something, and let me try it for 6 months or so, then atleast I could show the insurance company that I tried. Along with all my other attempts. Three of which were supervised, and documented. I know that this surgery is not going to be an over night thing for me. I'm expecting 1 - 2 years of fighting. Heck, could be even longer, but I am going to keep fighting for it. I just hope that one day - insurance companies will approve this procedure and save the lives of many people. Thanks again so much for your helpful information! You are all awesome! ~ Kari ~

Thanks so much I will be making a doctors appointment sometime in the next two weeks for a physical. I may ask the doctor to try and put me on something to assist me in losing weight, and I can try that for about 6 months. (That's if my ins co. will pay for that.) Then if whatever the doctor prescribes doesn't work - it just gives me something else to use to my advantage I suppose. I also want to go and get checked out for the chest pains that I have been having. I have no records of any of this, except for when I was in the 8th grade, I had bad chest pains, and had to get an EKG ect... (I don't remember the outcome of that test). I figure, the more information that I can get in my medical record - the more it can help me. I don't want to try and appeal, with nothing to prove. And later down the road, if they deny me, there is always the option to try and finance the procedure, or see if the insurance co. will pay half. Thanks again for your help! ~ Kari ~

OOOkkkay...here is the low down on my insurance. I called my ins. co earlier, and spoke with someone to see if my insurance covers this type of surgery. I was told by the lady that she would have to find out, and call me back. Well - no one called me back, so when I was on lunch, I was talking to my Aunt about it. Since she works in HR - she said that there is only one lady that she deals with at the insurance company. So she said she would call her for me and find out if they cover the Adjustable Gastric Banding procedure. My aunt just called me back a few minutes ago, and informed me that they ONLY cover the procedure if it is Medically Necessary. The lady told her that normally they do not approve this procedure. She said that 99.9% of the people trying to get it, are denied. The lady who she spoke with said that I would have to go a PCP - and they would have to state whether they think I need the Adjustable Gastric Banding, or not. So I guess from here - it's off to see my PCP. I'm definatly not getting discouraged about this, and this will not stop me from persuing the surgery. I'm sure it will take me a while - but I have nothing but time right now. Thanks again for all of your support, and help answering my questions. You have all been wonderful to me! ~ Kari ~

New Hope - Thanks for telling me about the Search area...lol...sometimes I forget that these sites have that option Debra - I am so happy that you had a great experience with Dr. Deol. I've been doing some reasearch, and she seems highly qulified! It also makes me feel better knowing that she has performed hundreds of lap band surgeries! And you are right! Rebecca is very very nice! I called her office this morning to go to a seminar on October 19th at 7:00. I am really looking forward to going!

Hello everyone - well I made the call to my insurance company. I asked if they cover Adjustable Gastric Banding. The lady kinda hesitated - and then told me that she would have to call me back shortly. So I am awaiting their phone call. In the mean time - I did make an appointment to go to a seminar with Dr. Zoe Deol. That will be on October 19th. So I suppose I'll sit here, work, and wait for their phone call! Thanks again! ~ Kari ~

Thanks for the replies New Hope & GeezerSue Yes - I will still call my insurance company today and see what they say. I was just getting antsy (sp?) over the weekend and thought I'd read their book lol. I definatly know not to get my hopes up. This is something that I believe I want done - and I know it will take time. I'm sure there will be instances where they will deny me. I'll get through it. I'm even thinking of other options if I am denied several times, like self pay, ect... Thanks so much again for your knowlege, and support! ~ Kari ~

Hello - I was just curious if anyone here from Michigan has gotten, or will be banded by Dr. Zoe Deol? I've started looking for a surgeon, and she seems like she is highly qualified. Thanks for any replies! ~ Kari ~

Welcome edistogirl2602 - congrats on getting banded! I am also new here - but not yet banded. I am still in the research phase - but right now, it's looking like getting the bad may be good for me. I'm hoping to be a bandster one day too! Please keep us updated on your progress! ~ Kari ~

Hello Alexandra & GeezerSue - Yes I checked to see if my coverage policy was online. It is actually located on our website for our company. My aunt who works in HR said that they do not hand out booklets with the information, because it is on our website - and we are able to print out pages from there. (The website is actually where I got the information from.) Even though they said the procedure is not covered - I too belive that there is a loop hole. So I decided to start doing a little research on a surgeon here in Michigan, and I believe I may have found one. Her name is Dr. Zoe Deol. I was checking her background in this type of procedure, and found out she has performed over 200 lap band surgeries. Her background in bariatrics is amazing. She does have some seminars coming up in October, so I am going to make a point to attend one of them, and get more information. Still - in the near future, I will be making an appointment to see my PCP. Before I go - I found something on www.michiganbariatrics.com - that states the following (under their Insurance section) ------------------------- "At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the procedure. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. And while insurance coverage for weight loss surgery is widespread, it often requires a lengthy and complicated approval process." ------------------------- Is there a way that you can find out whether your state has passed this legislation that requires insurance companies to provide benefits for this procedure? I read it over, and over, and was just curious about it...lol. If no one knows - that's okay. Thought it was worth a shot to try and find out. Thanks again for all of your help. You are all so wonderful! ~ Kari ~

Alexandra - I found out that with my insurance provider - we do not require referrals for any kind of doctor. As long as he/she is within our network. Should I still try and get a referral from my PCP? I just figured it looks better if your doctor refers you somewhere. Thanks again! ~ Kari ~

I was just doing a google search on Health Insurance and the Lap Band surgery. I found this article, and found it to be informative. I thought I would share with everyone what I read. (I'm sure some of you may have seen or read this already) but here is the link anyways I felt it dealt with insurance, so decided to post it in this forum. ~ Kari ~ The Article

Thanks so much again Alexandra - you have answered ALL my questions to a T. Now I feel like I know where to start! I will sit down today and write down everything that I can remember in my dieting attempts. My mother remembers some things from when I was a younger child, so she can help me out with this too. (I told her that I'm looking into the surgery - and she is very supportive.) Soon - I will make an appointment with my PCP and go from there. I will be sure to keep you all updated. Thanks SO MUCH again for taking the time out of your day to help answer my questions ~ Kari ~

Thanks Alexandra Glad that you might be able to make some sense of this. It seems like they make this so difficult so no one can understand it...lol. I've felt a little bummed since finding this info - but I'm not prepared to give up. I believe that there is a loop hole here too - and I REALLY want to jump through it. I figured I could also argue with their statement that is throughout the entire book. It says - "Unless Medically Necessary". Well - I believe that this is medically necessary, and I'm sure a doctor would agree. *** Now I have some questions... How much proof should you have that you have tried many diets, ect??? I have three records from weight loss centers where I have tried to lose weight. One from back in 1996, 2003, and 2004. Plus back in 2000/2001 I was on Xenical for a while, which obviously didn't work. Plus I have a long list of other diets I've been on. Should I write this list down? Should I try to include dates? If I go to my physician for a physical, and talk to him about the Lap-Band, what will happen from there? My experience with doctors is, that they note what you asked them, but never try to refer you anywhere, or encourage you to follow through. After seeing my physician - how do I get this process rolling with my insurance company? (I'm REALLY lost there!) lol. I've seen that some Lap-Band doctors in my area offer a program where people come in, and they talk all about the procedure, and it's free (kinda like a consultation). After that - do I contact the office of the surgeon that I plan to use, and have them start the insurance process for me? Sorry for all of this being so long. You have all been so very helpful to me, and I appreciate all of the advice that I am given. Thanks SO MUCH for everything! ~ Kari ~

Also - this one is from the "Surgery" section of the book. Below is the list of what they do not cover... ------------------------------------------------------------------------------------ Surgery for the purpose of weight reduction (examples: gastric bypass, stapling, etc) Sterilization reversal Artificial insemination, in-vitro fertilization or embryo transfer Cosmetic surgery, except when: · necessary due to an illness or · as a result of a congenital defect which interferes with bodily functions · for scar revision to correct a deformity caused by an accidental bodily injury or surgery hair removal or replacement Surgery and associated charges for the correction in the size or shape of any part of the body Face lifts, eyelid lifts, skin tucks or excision of fatty tissue

GeezerSue... This is what the first part (that says "unless morbily obese) states. (It is about two pages in the book - but here it is). Hopefully this will help. The part that I am talking about is bolded Thanks - ~ Kari ~ ------------------------------------------------------------------------------------ HOSPITAL-INPATIENT MEDICAL CONDITIONS Hospital inpatient charges are covered as provided below. Hospital confinements should be verified through the hospital verification system. Days of care that are not verified will require documentation of the need for inpatient care in order to be considered. FOR: Admissions for a covered surgical procedure, an illness (including pregnancy) or the medical treatment of a life-threatening medical emergency or an accidental bodily injury Hospital room and board charges for a semiprivate room, coronary care unit, intensive care unit, special care unit and isolation Hospital extras during a covered hospital confinement Charges of a skin bank, bone bank and other tissue storage banks Prosthetic appliances, either surgically implanted or external Confinement solely for physical therapy for rehabilitation following a hospital confinement for the same illness or injury Hospital confinements for laboratory testing and x-rays when medically necessary due to a concurrent hazardous medical condition Respiratory therapy by a licensed respiratory therapist Charges for a private room in excess of the semiprivate room rate Rest cures Hospital confinements for procedures which are not covered by this plan Charges for patient convenience items, including - but not limited to -telephone, television, guest trays, and guest beds, etc. Confinements for custodial care or physical check-ups Weekend admissions for conditions other than a life-threatening medical emergency or accidental bodily injury MEDICAL CONDITIONS (Continued) FOR: Confinements prior to the day of elective surgery Days of confinement not verified by the Plan Supervisor or supported as necessary by medical records Services rendered in a hospital operated by a municipality, state (except the Medical College of Ohio), the U.S. Government or an agency of the U.S. Government, except in a V.A. Hospital for an illness or injury that is not service related Hospital hotels Confinements for the purpose of weight reduction (including gastric by-pass, stapling, etc.), unless morbidly obese Days charged when the patient is on leave from the hospital Charges for 23 hour outpatient observation care in excess of the cost of one day care at the hospital's semiprivate room rate Hospital confinements during which only dental procedures are performed, except when necessary due to the age of the patient, a concurrent hazardous medical condition or a medical need to utilize the facility Hospital confinements which begin before the covered individual is eligible for benefits Charges for room and board by a facility which is not defined as a hospital ------------------------------------------------------------------------------------

Thanks I'm sure I will still call - but from what it looks like - it is a big "no". It pretty much states that this surgery is not covered. I just wouldn't know where to go from here now. Is fighting them an option if they definatly say no? I wonder if down the road - there would be a way for me to find an insurance provider that covers this surgery. I'd have to pay the premiums out of my own pocket - but wouldn't it be worth it? Guess I may have to check into that down the road. lol. Anyways - as always - thanks for the reply! ~ Kari ~

Well - I've just spent the last little bit reading through my entire insurance benefit book. I read every page - word for word...literally. I came up with 3 different things - and they were all in 3 different sections. Here they are in the correct order in which they were found, and what section they were found in.... ------------------------- Hospital - Inpatient Medical Conditions "Confinements for the purpose of weight reduction (including gastric by-pass, stapling, ect.), unless Morbidly Obese." ------------------------- Laboratory / Pathalogical Testing "Tests associated with weight reduction or smoking cessation programs" ------------------------- Surgeries "Surgery for the purpose of weight reduction (Examples: Gastric by-pass, stapling, ect...)" ------------------------- It states that NONE of the above are covered I'm kinda bummed. The first one throws me off though - where it says, "Unless Morbidly Obese" Now - since my insurance states that none of these listed are covered, does this mean that the surgery is NOT possible at all? Can I try it - and appeal? This is all new to me, so I'm sure I will be confused with it all. Has anyone been able to get the surgery when the insurance first says that it is not covered? Thanks for any replies! ~ Kari ~

Good luck to everyone who is getting banded soon! Be sure to keep us all updated on your progess! Hopefully I'll be banded one day too! ~ Kari ~

Thanks Alexandra I will be sure to do that. Could it also help if I give my doctor a copy of my medical records? I just got my health insurance back on the 1st of July - and have only seen the doctor once. (And this is a new doctor - no one I've seen previously). The last time I actually went to my family physician - I was 18 or 19 years old. Now my physician no longer there due to his own health reasons. Can my new doctor even keep my old medical records? Just curious if this would help me out too - seeing as my weight has always been an issue since I was little. Thanks again! ~ Kari ~

Hi all. I'm still considering the band, and doing my research. I noticed on the board that many of you use the following PB to refer to something. I just don't fully understand what PB is :nervous Could someone explain? Thanks a bunch! ~ Kari ~

Hi Rose - congrats on getting banded! Glad to hear that everything is going well for you so far! I am feeling more and more positive about this. I get a little nervous about the whole insurance thing, but I know I can fight it. I'm strong lol. Please keep me updated on your progress Rose! You'll be feeling great in no time at all!!! Thanks again! ~ Kari ~

Wow - thanks again for the replies. You are ALL wonderful, and supportive! I think monday will be the day that I call my insurance co. and see if they cover this surgery. I will definatly get in with my doctor, and see about getting a physical. I haven't had one of those in a loooong time...lol. Oh - I also wanted to know.... how do you know if the doctor will put the 278.01 code on the paperwork? Do you have to ask him to do that? Luckily - if my insurance co. needs some type of proof that I have been on "diets" ect... I can give it to them. I *should* be able to get the records from the Medical Weight Loss clinic from back in the mid 1990's. And I should also be able to get the paperwork from a year ago when I was attending their program. Also - this past summer I signed up for the L.A. Weight Loss center, but quit two weeks later, because I was so discouraged about my weight. I should be able to provide them with that paperwork too. I used a BMI calculator today, and found out that my BMI is 53!!! Sheesh. I feel so yucky about that. How I let myself get this far out of control - is beyond me! Now it's time to try and take control of my body! Thanks again for the replies. I will call the insurance co on Monday - and let you all know the outcome of everything! ~ Kari ~

Thanks so much New Hope & Slenderella - I want so bad to pick up the phone right now and call my insurance company - but unfortunatly I am at work during the day, and I share a large cubical with my co-worker. Though there is a small divider to divide our space - there really is no privacy on the phone. She is the last person that I would want to know about this. I will have to do it on Monday while she is at lunch. No biggie. I am just going to keep praying that this is covered. Slenderella - I am in S.E. Michigan - just about 2 or so miles south of Detroit. I *think* I've heard of those apple orchards before. My fiance' wants to go out there this fall.