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 ~