4jin

Hi, I live in St. Marys, GA and I am trying to have the lapband done I have bc/bs but I am not having any luck they said they don't cover it I want to have it done and I have a letter from my doctor stating that I need to have it done any advice from anyone? I too am in Georgia. I have BCBS of GA. I spoke to my HR who told me they knew AETNA covered it but were not sure about BCBS. I went to them because I didn't want to call the insurance company...(paranoid they will know before I try and deny me)...so she advised me to call them and just give your group employer ID # and they can pull up the certificate of coverage booklet. I called them and did without giving them my info..just as she said with my group ID# and they were great and understanding. She even gave showed me how I could get to it online and print out for my records and gave me info about if it is approved and down the line I have 100 lbs or more to loose how I could qualify for an ab..something or the other in our terms tummy tuck.... I was very suprised with their customer service... Just try calling...if not comfortable giving your info..just do what I did...they will still give you the info because you identified yourself as an employee and are giving them the employer group id#. Hope this helps.....oh..and they told me my employer plan pays 100% At the beginning of the call I was :speechles:cry But I ended with a :nervous Good luck!

<p><p>Ok....taking all advice I have received...I wrote down all the medically supervised plans, all the non-medical plans, all the pills, diets...gyms...methods...I have done over the past 7 years....Wow there is a lot of them. No wonder my husband would give me that here we go again look everytime I mentioned something about loosing weight...</p> <p>I gathered all that info...and found address and tel#'s for all doctors as well that have medical info or where I have gone for other things but have my weight and vitals documented. </p> <p> Most I have to wait for a call back...One of them was successful at the first try and I paid the fee over the phone and will be receiving my records, another I faxed the authorization form and should be in the mail to my PCP by the end of the month. It went better than I expected. </p> <p> I even found my gym membership contract. </p> <p>What I found interesting was why most even ask why am I requesting MY records...hello...last I checked they are MY health info. Don't I have a right to see it if I want without having to tell you what it is for....but as a true professional, friendly person...I gave the politically correct answers....darn it!!!</p></p>

On January 2007 I placed my own self on a medically supervised WLS program. Before I decided to go such a route as to having anything placed, replaced, removed..added...whatever you may call it.....or anything dealing with a hospital or anesthesia or pain I tried it. I have put more effort in my life loosing weight and trying to keep it off in a month than most naturally "skinny" will ever try in their life. I was on the medically super expensive medically supervised plan for over 6 months the weight came off but very slow. It was working don't get me wrong, I even recruited a buddy to the program. I motivated co-workers and we even signed up as a team for a marathon-walk. Which by the way we accomplished. But I became fustrated....even the Doctor was fustrated...he recommended me as an excellent candidate for surgery. He advised me to research it. I left it alone for a couple of months. I was exercising more and am trying harder than anyone else that ended up going to the Doctor because of me and signing up for the medically supervised plan...yes it is fustrating when people that started after I did lost more than I did. There is even a wonderful story about one that has lost almost 65 lbs. Yes the doctor admitted for all the efforts I was putting in my loss should have been greater. But ofcourse blame it on anything but an attempt to find out exactly what it is...he said sometimes genetics are what they are and only true long time maintenance that is offered is surgery for a healthy life. Not this constant rollercoaster my weight has always been. is it fair...of course not...but I am aware life is not fair. Did I stick to it ..yes I did...heck yes.. Is it plainfully hurting to hear the own doctor I am paying big bucks to say...well you have been carrying that weight around for such a long time your body will resist. The angry part is I was flippin' paying for the whole plan. As a matter of fact I have two medical insurers one from my employer and my husbands employer plan as secondary...but guess what... The program is not covered.....who paid for it....I DID!! I paid for it all. The consults, the pills, the shots, the lab work. You name if...he blinked....I blinked...I wrote checks.... I was going to the gym either at work or private....I walked with my buddies on breaks & during lunch..... Committment...you name it I have had it....then why does this not work? Exactly what the doctor said....other options exists for people in your situation....thank goodness...however so I don't have to continue closing my eyes and writing checks....those two cards that have been collecting dust in my wallet will be put to use..... I called both insurers and they both cover obesity surgeries. I received a copy of the general requirements....And I do meet all of them...Now the process just begins... I hope my fustrations don't offend anyone.... But I do wish that my fustrations and experiences do help someone who has started this process and is in the same boat ride as I am.

I haven't been able to post. Very busy...but I guess it helped get me distracted and worry free for a couple of days. I am a worry freak and will be until I am approved. then I will find something else to worry about i'm sure. I went thru my mail and it looks like yesterday I received my informational package and confirmation of seminar for Nov 15. Now I am more excited than I was previously....jeezz.. can't get over myself. Also I will be checking out body bugg.....looks like i'll be buying that soon as well. thanks for all your advice ,....that is great...no one better to tell my story than myself to the insurance company.... I guess it should not hurt....

Thanks guys.....I started tonight gathering and searching online all the doctors names, address and tel#'s that I have seen the past 5 years so I can contact all the offices and request all medical records from each one. I hope I can gather enought to show routine checks were my weight will reflect I have been at a bmi of 35 or more for all these years. Can't hurt to have too much can it?

Hi there. I too am choosing Dr. Johnson at Atlanta Bariatrics with Northside Hospital. Have you met him yet? I am still at the beginning process of this whole thing. Any advice that might help me speed up some steps? Congrats on getting approved. I've heard that insurance is sort of tougher than most to qualify.:clap2:

Ofcourse I will have to meet my yearly deductible..but $500 is better than $18,000 or $19,000 anyday in my books!!!:clap2:

Good Morning!!! I listened to all of the help and advice I was given. I called my HR...I can keep my same insurance for next year..!!! Yes.... So I will still have BCBS GA. HR did not know if lapband is covered so she gave me the number to contact our benefits coordinator. I called holding my breath... I spoke to a member services specialist I think her title was...she was great. I just gave the group code and she pulled my employers policy. She verified it is covered. She gave me directions how to obtain a physical copy of all the medical policy, the guidelines, requirements, CPT codes, etc.. She even gave me info for future if medically necessary can have tummy tuck covered as well but must loose 100lbs. WOW!! I printed the policy and it looks like I meet all the general guidelines, now I just need to start the process of requirements once I meet with the surgeon...the usual...mental health assessment, psychiatric profile, have doctor explain outcome...etc... etc.... Requirements: Medically Necessary: 1. BMI of 40 or greater or BMI of 35 with co-morbid(just one)(sleep apnea, obesity cariomyopathy, diatetes, hypertension) 2. Patient must have actively participated in non-surgical methods-these are evaluated and appraised by the physician requesting authorization for surgery AND 3. Physician requesting surgery must confirm the following: Psychiatric profile, post operative expectations explained and addressed, undergone a preoperative medical consultation, mental assessment, explained risks, benefits, uncertainties and procedures of surgery, pre and post diets and nutritional counseling (yes they cover it with a certified nutritionist/dietician), and counseling for exercise, psychological issues and support resources. I am so excited I can barely contain myself.... I can breath the odds for once are in my favor..... Needless....from reading other threads I am aware the small battle will begin....until obtaining official approval. but can't help it.....can't hold back the excitement.

kat817 thanks so much for your refreshing info. You are a true inspiration. 103 lbs lost WOW!! I went online to obtain a copy of the certificate booklet and it says I have to call and ask for it....convenient right.... I will be calling tommorrow and requesting the requirements be faxed to me. I will began working on writing dr offices and tel#'s so I can began requesting records. Hope to hear more advise from you soon.

Is it easier with BCBS or with AETNA? Does anyone know?

For my story if any1 is interested please go to new..and feeling lost. Thanks

Thanks Buttercup for all your info. Wow renewedhope that WL is great! If anyone is interested in my store please to go

CONGRATULATIONS!! THAT IS GREAT! i

:faint:Emory is out of control...!!! I called yesterday and scheduled what I thought was the info seminar. She gave me a date of Nov 7 right....well guess again.. :rain:I got a call this morning that the session was closed and by error i was double booked. For sure when it rains it pours!! Unless someone calls last minute for cancellation I have to be reassigned to the next meeting which is not until DECEMBER 5!! What....R U PEOPLE CRAZY.....I can't take this madness. So I did what you guys suggested I brainstormed....found out both BCBS and AETNA gladly work with Northside Hospital... Even better news....So when I do transition from BCBS to AETNA I should not have any problems at all!!!! Northside here I come...so I called them up... YES! No round abouts of Optifast meetings or anyother one of those things!!! was offered next Wed Nov 7!!! yeah...yeah....:bounce:but it is at 7:30PM.... can't homework time...etc.... so I had to take the next one I said scared when is the next available...... crossing my fingers hoping ....please..please...please.. not December .... YES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! The following one available is Thursday Nov 15th...:bounce:the nurse must have thought i was crazy!!! I was that happy!!! now that's what I call service..! She even explained I will be emailed instructions/information to help decide if surgery is the right journey for me...if it is which method would be best and what medical information I should start gathering. Finally results!!!........ My journey is on it's way.....:biggrin1: I should be able to schedule appt with surgeon on the spot after the meeting session....AWESOME!!:bounce: Take that Emory....:clap2: Thanks guys

thanks guys all this information is great!!! My insurance currently are primary BCBS HMO and secondary BCBS PPO. But of course have to have a but.... eff 1/1/08 I will have AETNA HMO as primary and AETNA PPO as secondary. Any info on these insurances anyone?

I live in Dacula, GA. I will be attending the seminar and hope to pick my surgeon from Emory Hospital in Decatur, GA. A bit of a drive but hopefully worth--it!

Hi ya' all who read this thread. I just want to be heard and find a connection with people who have a similar story. Here it goes... I have been overweight all my life. I can only remember a few times when I wasn't. I grew up with two brothers who ate what they wanted and were at normal weight. My mother would go out of her way so I would diet. I have been on every diet imaginable from SlimFast, to diet pills from GNC, joined gyms, Doctor paid for medically diets and exercised programs, Soup diet, cabbage diet, south beach, WW,.....on and on.... Some worked others were a joke..... But needless to say gained it all back. I am right now the biggest I have been in my life. I am so unhappy with my weight. I feel as thought a different person in my is trying to get out but none of what I do helps for the longterm. I am tired of feeling the shame, of looking in a room to see if I am the biggest person or not. but mostly I am tired of the loose, gain...loose gain...gain twice as much as I lost...etc... I researched last weekend gastric bypass as it has been something on my mind for years now..but couldn't help feel guilty or like a failure for turning to what some people refer to as the "EASY" way. I know I need a medical intervention to win this battle and be at a lifetime healthy weight. So I got over it and researched this past Weekend and came across this lap-band. I love it...I have decided this is what I need. I scheduled to what I thought was the informational seminar yesterday. It was an info seminar alright, but for Opti-Fast...what the crap...insurance does not pay, can only be cash or financed with the lender of the choice and cost $5,000. yeah right...walked right out... waisted 4 hours of my day in traffic, and away from family for that! So I called the number I called initially and was finally scheduled for the correct seminar but i have to wait until 12/5/07. My only concerns now are this. I am 5'2" and W 233lbs home scale. No comorbidities.... have documented doctor program from beg of this year in January until July 2007. Prior to that back in 2005 was the last doctor monitored program I did. I can probably get weight info from my gynecologist when my daughter was born back in 2002 of my weight prior and after pregnancy as I believe was a bmi slightly under insurance guidelines. I will have AETNA HMO effective 01/1/2008. I am snoring at night and began having asthma which I believe is weight related as well. My questions are as follow: Does anyone have any advise of how my case looks? Do I stand a chance at getting approval without a long battle? What is the process after attending the informational seminar all the way to the doctor's submittal to the insurance? HELP desperate to know!!:help::confused::confused:

Bandster 1007, I am glad you took Wassa's concerns to the positive. In light of the matter, I want to thank you for being honest on the forum and letting it out your experience. I am just starting the process be it the very beginning where tonight i will be attending the informational seminar. I have been doing my research before I make my decision this is the best method for me. Your experience and the honest wake up that Wassa gave us all yes...i think even myself--because It is showing this can happen to anyone same mentality of a diet needs to go. Maybe you should try group meetings or try taking a walk. I read find something to replace the cravings... Good Luck....And congrats on the LOSS!!!!

Thanks for the quick reply zengirl227. It is a relief to hear that. I have no clue what am doing. I just recently searched the lap band procedure online this past weekend. I don't know what awaits or what I need to do after the seminar. What was your initial BMI? And congratulations on your LOSS!!! way to go!!

I too am in the Atlanta area. I am going to attend the information seminar at Emory on 10/30/07. I am glad to hear your process has not been that long. I pray mine goes just as smoothly. My primary insurance is BCBS Select(HMO) currently until 12/31/07. My secondary is BCBS PPO as well. Effective 01/01/08 I will have AETNA(HMO) and secondary AETNA PPO. What is your BMI? did you have any co-morbidities? I am desperate to know if I will be having to face a battle with my insurances.:help:

I am in Georgia as well. Over the weekend I searched the internet and came across lap-band. This is great!! I have been overweight all my life. I have been on a diet all my life!!! When I talk to my mother on the phone who is hundreds of miles away....after asking if everything is fine-she asks how is your weight---are you loosing any?... Yes i'm tired of it. My BMI is 41 it seems it is on the edge of extreme not extreme. I don't have any other medical conditions that I am aware of besides seldomingly I know my blood pressure is high. I have AETNA HMO. Does anyone know if i have a good chance of getting approved? I will be attending an informational seminar at Emory on 10/30. I am desperate to know if my insurance will approve. :help: