allykat

Can they just redo it and resubmit?

I'm pretty excited! After finding out about a month ago that my insurance excluded WLS from my plan, I've been investigating self-pay options. I hated to go through a finance plan, but ultimately it is what DH and I decided to do. Anyway, I have all that worked out and today, I spoke with my physician's office and have a surgery date: 2/28! I am going Wednesday for all the pre-op stuff and then I am all set. I cannot believe this is really happening!

I'm excited! I finally have the financing in place so I have an appointment with Dr. Bagnato on Wednesday and surgery is tentatively scheduled for 2/27! I can't believe this is finally happening!!!!!

At my seminar, someone asked that question and the surgeon replied that no, he would not do the surgery on someone with previous gastric surgeries. Not sure if that is just his stance or a practice among all surgeons...

Hi everyone, I am in the process of having the band and am trying to decide when is the best time for surgery. I would of course like to have it as soon as possible, but I have some work obligations and travel coming up. How soon after the surgery can you travel? It is a 5 hour car ride and I won't have a great deal of lifting to do or anything. Any advice?

Apparently, I'm really excited...double post here!

Hey all...I'm also from S. GA and hoping to be banded by Dr. Bagnato soon. I'm working on the money portion now since I'm self-pay. About $4K more to go!

I'd switch PCP and find someone you are comfortable with. As for your mom and husband, maybe they just don't understand the surgery. Find one of the videos online for them or maybe take your DH to your appt. with a bariatric physician. Good luck!

Georgia Girl, I'm from Thomasville. Thanks for the kind words. I'll probably set up an appointment with Dr. Bagnato soon.

I'm excited for both of you! Cool!

Awesome news about your surgery being scheduled soon. I've hit a roadbock. Now that I know my insurance has an exclusion clause, I'm at square one with trying to decide what route to take. The good news is that I can then use the first pick I had (Dr. Bagnato) rather than Dr. Crooms in Tallahassee. The bag news is that I'm self pay now. YUCK! I'm checking into options on how exactly to pay for it. My husband is against a second mortgage and we are actually closing on a refi next week. Is Care Credit a reputable company?

I have UHC and thought I was all set. I called with the procedure codes and was told it was covered 90% with approval after predetermination from doctor. I was psyched! After reading about another State of GA's problems on this website, I decided to call back and verify. This person was great, but she said it was excluded from our policy and that it would not be covered. She did say I could gather documentation and appeal it, as I would any uncovered claim. I could also file an appeal before treatment to avoid uncovered expenses. So my question is - do I have a prayer? Is there any hope? Without insurance coverage, I know I cannot afford this - there is no way. I cannot afford to finance this and have no clue how I could get this otherwise. Any advice from BTDT folks?

I am just so disappointed about this. I don't think selfpay is an option right now because I don't have that much built up and I really don't need another payment. I just don't know what to do.

Kirby, I'm going to join you in being disappointed! I called UHC this morning and used the CPT code and also gave the name of the procedure and asked about exclusions. You were told correctly, weight loss surgery is excluded. However, she did say that if it was approved by our company, they cover it. She suggested submitted an appeal complete with medical documentation and just see where it goes. I was soooo ready for this and now I'm soooo disappointed!

I don't know who I talked to, I just called the 800 number on the back of the card and told them I was considering a procedure and wanted to know if it was covered. I found the code on the "Insurance" subforum here, under one of the stickies. Here it is cut and pasted: 43770 – Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components). I gave them that code and then said the lap band procedure and they said it was covered! Let me know what happens when you call back. I'll call again tomorrow as well.

But what I basically said there was that I also work for the State and have UHC and was told it was approved. Trying calling with the procedure codes and see what you find out. Good luck. You've made me nervous now that maybe I was given wrong information!

Now you've made me nervous! I also work for the State of Georgia and have UHC. I called and asked specifically about the lap bad and used the procedure codes I found on this board and I was told yes, it was covered 90% inpatient or outpatient. Not sure why you were told that? I repeated the code back twice and even told them the name of the procedure and they said it was subject to individual review of the physicians predetermination form or something like that. Try calling again with those procedure codes!

When I spoke to my coworker today, who is a licensed professional counselor, she agreed to write my letter for me. She knows I am the type to not do something like this without lots of thought and research and she knows I'm emotionally stable...lol - most of the time!:smile: I've left a call for the nutritionist to call me, so I'll take care of that and have everything out of the way before my appt. I'm hoping I can go on the 14th and get approval pretty quick after that. I'm very busy at work April - May, so I'm hoping, as unlikely as it may be, for a late March date. Doesn't hurt to try!

Thanks everyone! I actually felt really comfortable with him and the nurse that was at last night's seminar. I've made my appointment and will now count down the days!

I went to the seminar last night and the surgeon stated he has performed about 100 of these procedures since 2005. However, he is a leader in laproscopic surgery and was the first in Tallahassee to do it. Is this enough experience do you think?

I had no questions other than the price of fills...lol. I knew some charged around $200, and he may do that for people who are not his original patients. I have researched this for a year, so I could have probably given the seminar! LOL! This site, especially, has been helpful. So now I am patiently waiting for 9 am when his office is open so that I can make my appointment. I did find out out that I can use someone of my choosing for the psych eval and nutritionist consult, so that helps. I really don't want to drive to Tallahassee for those. I work with a psychologist, so I plan to talk to her. I really didn't want to tell anyone about this, but I think I can trust her! Waaaa! I just called for my appt. and it isn't until 2/14! Don't they know I wanted this yesterday? I wonder if I can get the psych eval and nutritionist visit over with while I wait?

Hey Georgia Girl, I have not yet met with the surgeon, other than meeting him in a room with about 20 other people tonight at the seminar! He seemed really nice. I like that with him, everything is really included for the first year - all office visits and all fills. After that, he only charges like $25-50 for fills. I was worried about that after reading how expensive they could be!

Thanks all! I was wondering if the nutritionist visit and psych evals were always required. I know my BMI is over 40 and I'd love to skip some of the delays and just do it already. I was told by the receptionist that the psych eval and report is what takes the longest, usually up to a month or better. I go for the seminar tonight and can then make an appt. with the surgeon, where I guess I'll find out for sure.

That was some bike ride! You are right, you certainly got in a workout!

I would have answered No to this question about a year and a half ago. But then I applied for this job that I was absolutely qualified for. It is in an academic setting (thought not instructional). I blew them away at my interview and honestly thought I had it in the bag. Then I got a letter that they weren't filling the job. About a month after that, a coworker who was a VP called me in my office to tell me that the VP from the other place told her that they loved everything about me but had real concerns about my size. I was completely shocked! This person who told me was completely offended on my behalf and let them know that it was totally their loss and she was actually glad they were stupid enough to pass me over. I looked at it as a blessing in disguise. Thank God I didn't get the job and go work with shallow people like that! It ended well, I was promoted at the place where I worked and I wouldn't change it for anything. Incidently, the person who spoke up for me left and had tried to hire me at the place where she is now working, so at least I know I'm not unemployable! The kicker? They ended up hiring someone from within for that job that had zero experience and really, she isn't a tiny thing herself.