JDUB0414

Shell, why did they deny you the first time and how did you get it reversed?

thanks. I did call them about my records and that's what they said would take a week to get back. I called back and told them, something needs to happen because tomorrow will be 30 days and expressed how ridiculous this was. I received a voicemail today from the nurse stating that the doctor was coming in to type up my husband and I letter and we can pick them up tomorrow. My husband will go to pick them up and stand there until they fax it over to the weight loss center. I will also have him get the copies of our medical records, just in case the insurance company needs something else. During our six month visits, she seemed as if she was very supportive of the surgery and said she wanted to make sure she provided us with everything they needed. I am hopeful that they will approve us. I will let you all know tomorrow what happens.

This is my story. The weight loss center sent over what I thought was all my paperwork on 11/19/07 to the insurance company. I received a letter from them on 12/7/07, after calling them regularly for two weeks with regards to the status of my file...stating that they need additional paperwork. I dont know whether or not to be pissed at the nurse at the wieght loss center or at my PCP office. The nurse said she knew exactly how Aetna works and would not send my packet to them unless she had the complete file. I gave them both the print out of what I needed to get approved. Well somewhere along the way our five year weight loss history didn't get sent. I called my PCP on 12/10/07 to ask them to send that info to the weight loss center ASAP and was told they would send it the next day, talked to them 12/15/07 and they still hadn't sent it and was told they would send it on 12/17/07. Talked to them this morning, and they still haven't sent it and would get it out by 12/21/07. Now on the letter I got from the insurance company, said I had 45 days till the date that the file was opened to get them the info or they would make a decision about without the five year history. To me this means they will deny it. My PCP acts as if it's not important enough to rush the letter and it will take a week to get a copy of my medical records. I dont know what to do. I am so upset!!! What should I do?:whoo:

Congrats Melissa, I'm happy for your approval. They've had my paperwork for two and a half weeks. I just received a letter today stating they needed the five year weight history for both my husband and myself. I am so upset, because I thought my doctor sent that info to the weight loss center. They said they will fax it over ASAP. I'm not worried about getting the history for myself, but I am for my husband. He hasn't been to the doctor like that. We are trying to figure out something. Do you know if they will just deny him, or will they look at the file and determine with what they have?

I talk to the insurance company on 11/29/07. They said they have all of our paper work and the file is still being reviewed. I am hopeful that we will have an answer soon. Please pray for both my husband and I to get approved:help:

wsb, I totally agree with what your saying. I actually clicked on section, Life After, because I wanted to know what it feels like to be at goal and living a life we are all waiting for. To find this this thread...it kind of took me for suprise. I've been reading and not posting so much since I started my process in May. I've researched and read all I think that I can about getting a Lapband, but that's just like having a baby...you can read everything about pregnancy and having a baby, but it will probably be different from what you've read. Talking to people about experiences is the greatest thing...it gives you hope. I'm a teacher, a high school teacher at that, so it's hard for me to get frustrated at people when they ask me the same question, or what I fell may be a simple minded questions. I learned a long time ago, that people may just not know what's going on, so they have to ask quesitons to get that information needed. There is no such thing as a silly question. I agree with people following the rules of their doctors, but, we all have been told by our PCP at some point in our overweight lives, that we should eat heathy, and exercise, so we can loose weight and feel better. Did we do this??? Probably not since we have gotten the band or will be getting the band. We all make mistakes...it's about fighting an addiction also.

thanks you so much. I will definately let you know what the outcome is. Where are you at with your surgery date?

My husband and I just completed the six month dr. supervised diet plan this month. I have all the requirements they asked for. My husband on the other hand doesn't have a continuous 5 year history proof because he hasn't been going to the doctor. They submitted our paperwork to the insurance company Friday 11/16, I am anxious and nervous about getting approved. I'll let you know how it comes out.. BTW: I have Aetna PPO

thanks for both your feedback. swstacey1977, i have everything that you have with a higher bmi though...so i'm hopeful that i get approved that fast. My husband on the other hand has everything but a ongoing 5 year history, that's only because he hadn't been to a doctor continuously like i have, so I'm worried about his. I will call them on Monday and let you know how it goes.

Congrats on your approval. I talked to my doctors' office and they will be sumbitting my husband and my paper work this week. How long does it take to get approval?

Pookie, I'm just starting my 6 month weight loss plan for insurance purposes....I know it will be a long a dragged out situation, but I'm excited. It seems like you will be fine once you get those two things in. Were you able to make the sleep apnea test earlier? Good luck!!!

I too have Aetna, but my requirements are 6 months of a PCP supervised diet or 3 months of a multidisciplanary plan at a hospital setting. I cant do the 3 months because its way too expensive and most are Meal Replacement plans. My question is do you think If my dr. submits my weight history and a letter explaining why she thinks I'm a good candidate for the lapband, along with my 3 months of visits with the recommended nutritionist will work? thanks, Jo

Hi All, I am also a newbie and so far have went to the first of six visits to my PCP which is required by my insurance company. My PCP has referred me to a nutritionist. My insurance will only pay for 2 visits for my lifetime!! That didnt make sense to me. Anyway, I've went to a HMR at the weight loss center at the hospital I'm having the surgery at but it's too expensive. The insurance says if I do that then I can get approved in 3 months versus 6 if I go to my PCP. I wish all of you luck and pray that well all get approved and become bandsters one day!!!

Thanks for your comments. My main concern is what will happen since I want to have more children. Yes I want the best results and I know I have to be committed to whatever I decide to do, but I want to do what will be good for me and my unborn child if I were to get pregnant.

Thanks all for your input, everyday I've been back and forth, but now I'm leaning more towards the band.

My husband and I went to the 1st of many doctors appts. today for the insurance approval. Our doctor said since we've tried almost everything, there was really nothing else for her to suggest is the hospital multidisicplinary program. So, she reffered us to one. I called today to get information and found out that it will cost over $3000 a piece for my husband and I to do this 20 week program. I called the doctor back and she said she will put us in touch with a nutrionist and we can make an appt. to come see her for weight updates every month for the next six months. Has anyone else experienced this when trying to get what the insurance company wanted? Any suggestions on some dieting programs I should try, just to have the information the insurance company will approve? Thanks, Jo

Chickie, Thanks for the advice!!! I'm looking into the pregnancy thing and how I could be affected by either. I'm sure that will help me make my decision.

Hi All, I'm new here from IL. For weeks now I've been researching weight loss options and have fell in love with the lap-band. Mainly becausing I want more children in the future and this allows that. Lately though I've been reading about the Gastric Y (I think that's what it's called) and have wondered about it also. I weigh 345 lbs and want to be around 170 one day. I would appreciate some suggestions on which would be good for the amount of weight loss I need and want. Also I'm in the process of starting my requirements of 6 month visits with my PCP or 3 months with a supervised hospital program. Does anyone have any experiences they could share regarding the hospital programs that are offered? Thanks..

Thanks for the response. Wow $20,000!!

Hi All, I've been on this site for about a week now everyday, reading threads. I am soo ready to get banded now. You all have been very helpful in making my decision to lapband. My husband has decided to do it with me. I've already talked to my insurance company, and am awaiting the paperwork from them. I've already made my first of probably many doctors appt. for the diet plan the insurance company is requiring. They are requiring us to wait six month before they approve it. They said we could do it in three months with a hospital program. Three questions: Does anyone know a faster way around this? How do find a hospital program? Can I get some input on how much this surgery costs? Thanks,

How long did it take them to approve? did you have to do the six month PCP diet program first?

jewelsismelting, that's my plan, only a few people will know. i will tell everyone else, if they ask, "it's just a diet."

Hi All, I've been on this site for about a week now everyday, reading threads. I am soo ready to get banded now. You all have been very helpful in making my decision to lapband. My husband has decided to do it with me. I've already talked to my insurance company, and am awaiting the paperwork from them. I've already made my first of probably many doctors appt. for the diet plan the insurance company is requiring. They are requiring us to wait six month before they approve it. They said we could do it in three months with a hospital program. Three questions: Does anyone know a faster way around this? How do find a hospital program? Can I get some input on how much this surgery costs? Thanks, Jo:)