KayleighsMommy

Hi there, I am in Aurora and I have been seeing Dr Melniczek he is at redrocksbariatrics.com I am waiting for my insurance to come through, but I know Dr Mel also takes self pay. I would highly recommend him (even though he has not actually performed my surgery yet) Good luck in your search.

You are right there ;(

Just got a call from the woman at the hospital where I am having my sleep study done... the insurance co told her I don't need a preauthorization...but that it is strongly recommeded, and of course...if I am found positive it will be paid for. Evidently, the problem is they consider this COSMETIC!!!! :thumbup: I don't care that I am requestng what they consider cosmetic surgery (sure....lap band could be considered cosmetic, I guess), I don't see a sleep study as being in any way cosmetic...this is a potentially life saving test....Lord save me from idiots (and insurance companies)

Best of luck. julie

Yep. That's what I thought. I know my doctors office called the provider number on my card, which takes them to the actual AT&T department at BCBS... who told them bariatric services are covered. Hard to beleive when they won't even pay for this much less expensive sleep study without enough red tape to choke you.

I have BC/BS of IL. I called my surgeons office to make a initial appt. they took my insurance info, called back and told me I had "excellent benefits" ... bariatric coverage, no copay, no deductible, no prerequisites, the insurance girl at the office told me she wished she had such good coverage. Now comes the rub... I am still waiting on a preauthorization...the doctors office said they faxed in on Wednesday...they claimed they never got it...she has been trying all day to refax it...been unable to get through. Also..the doctor is sure I have sleep apnea (by my symptoms) he will not do the surgery without a sleep study (btw..I also have a incarcerated hernia he will fix at the same time) The problem is BC/BS is giving a hassle about the sleep study...they want 12 months of documentation of sleep issues...now correct me if I'm wrong...but if you have been compaining to your doctor about waking up gasping at night for a year and your doctor has not already sent you for a sleep study, isn't he pretty much a moron????? I called the ins co today to find out what they want...they had it documented that I had a BMI over 38 (way over), extreme snoring, daytime sleepiness, etc. The service rep game me the runaround...told me it could take anywhere from 14 days to 2 months for a reevaluation, once my doctor sent all the required info....which of course, they did, since she told me what was listed. She kind of suggested I keep my scheduled appt and send it in for reevaluation. I asked her if they found I had sleep apnea would that be considered medically necessary for the test. She actually had the gall to tell me "it depends on what your benefits are"...mind you this is after going round and round for 30 minutes about what "medical neccessity" is. I told her "You're the one with my benefits in front of you...tell me what they cover". The first thing they she said was medical neccessity can be determined by a sleep study WTF?????? :tt1: At this point I was almost in tears, practically yelling at her...then my cable went out and dropped the call. I am sooooo livid at his insurance co. What is the chance of them paying for Lap Band if they won't even pay for a simple sleep study??????????????????? <rhetorical question...just my frustration showing> Sorry for the novel...just had to vent. __________________

That's the problem...they tell me it is covered...if it's "medically neccessary", and according to what she read to me medical neccessity can be proven by a sleep study. All I know is they WILL NOT authorize it without 12 months documentation, though they did tell me they can send it for review...that will take 2 weeks to 3 months!!!! Oh well, I guess if they refuse to preauthorize the lapband surgery, as I suspect they will..after reading how hard it has been for everyone else (even though my dr's office was told bariatric services are fully covered) I will have plenty of time to fight them over this test <sigh> I cannot find anything on the bcbsil website. It really is not very user friendly. Hmmmm..what a suprise...NOT!

Gina, Just wondering who the empoyer is that supplies the insurance?? Mine is through my husband who works for AT&T (just wondering if it makes a difference wether they pay on a company by company basis) julie

I can't believe how their customer service gives absolutley NO service!!! Unbelievable.

Oh, man..that sucks. I am so sorry. I guess I should not have been expecting it to be easy. I tried to have gastric bypass done abour 12 years ago...BC/BS of MI denied me then, too. At the time I was soooo miserable about it...if anyone even asked me how my fight was going I would get hysterical and start crying. I finally just gave up (after a face to face meeting at BC/BS in downtown Detroit) This time I will not give up so easy. But geez...a simple sleep study??? Is that really too much to ask for??

I gues they are ;(((

That's the thing...the girl at the doctors office told me they send people for sleep studies every day and have never heard of this before. The woman at the sleep center told me she has NEVER seen this kind of insurance pushback on a sleep study either. Figures they would have to start with me <sigh>

I also have BC/BS of IL. Reading all your stories made my anxiety level go up a few notches. I called my surgeons office to make a initial appt. they took my insurance info, called back and told me I had "excellent benefits" ... bariatric coverage, no copay, no deductible, no prerequisites, the insurance girl at the office told me she wished she had such good coverage. Now comes the rub... I am still waiting on a preauthorization...the doctors office said they faxed in on Wednesday...they claimed they never got it...she has been trying all day to refax it...been unable to get through. Also..the doctor is sure I have sleep apnea (by my symptoms) he will not do the surgery without a sleep study (btw..I also have a incarcerated hernia he will fix at the same time) The problem is BC/BS is giving a hassle about the sleep study...they want 12 months of documentation of sleep issues...now correct me if I'm wrong...but if you have been compaining to your doctor about waking up gasping at night for a year and your doctor has not already sent you for a sleep study, isn't he pretty much a moron????? I called the ins co today to find out what they want...they had it documented that I had a BMI over 38 (way over), extreme snoring, daytime sleepiness, etc. The service rep game me the runaround...told me it could take anywhere from 14 days to 2 months for a reevaluation, once my doctor sent all the required info....which of course, they did, since she told me what was listed. She kind of suggested I keep my scheduled appt and send it in for reevaluation. I asked her if they found I had sleep apnea would that be considered medically necessary for the test. She actually had the gall to tell me "it depends on what your benefits are"...mind you this is after going round and round for 30 minutes about what "medical neccessity" is. I told her "You're the one with my benefits in front of you...tell me what they cover". The first thing they she said was medical neccessity can be determined by a sleep study WTF?????? :tt1: At this point I was almost in tears, practically yelling at her...then my cable went out and dropped the call. I am sooooo livid at his insurance co. What is the chance of them paying for Lap Band if they won't even pay for a simple sleep study??????????????????? <rhetorical question...just my frustration showing> Sorry for the novel...just had to vent.

I went for my initial consult last week. The surgeon told me he is sure (by my symptoms) that I have pretty bad sleep apnea. He wanted me to go for a sleep study, then wear a CPAP at least 2 weeks before surgery. The doctors office called and said the insurance co wants all sorts of documentation (12 months documentation, a letter from my PCP, I don't even remember what else) I don't have 12 months documentation (really..who does???) I mentioned to my PCP a year or so ago about wanting a sleep study...but she said I had to go see a pulmonologist first...I didn't bother. All this hassle over a sleep study...what is the chance of them paying for a lap band???? I am so bummed...still waiting for word back from the insurance co regarding the preauthorization. And...even if they do...I am concerned the doctor will not do the surgery without the sleep study. I am really down about this.

I have no problem with going to the sleep study..just can't believe BC will not pay for it without all these other prerequisites

BC/BS of IL. Any suggestions on any way to push it through without jumping through their hoops?? I just don't think I will be able to get the documentation they require.

Yep...gotta agree with you there,,,though I just keep a closed garbage bag next to the toilet, and toss them in there (guess I'm used to it after potty training my daughter :biggrin:

When I called my surgeons office to make an initial appt they took my insurance info, the girl called back to tell me I have great insurance, no copay no deductible, no pre requisites. I had my consult last Wed, and they were going to submit my preauth Thursday or Friday. I am now impatiently waiting for a call back from the doctor. I am sooooo paranoid and worried the insurance company told her something in error!!! I am so afraid to call myself..I don't want bad news :biggrin: Hopefully I will hear back early this week. BTW...I have BCBS of IL.

AppleBottom...I know what you mean. I am so excited about moving forward on this surgery (just had initial consult last week...waiting for insurance preauth before doing the sleep study and psychologist). But I am so afraid of "losing myself". I guess it is something we just have to get past :biggrin:) to go on to the next phase of our lives.

You might want to think about getting some baby wipes. ( I recommend Huggies Shea Butter) They will be so much better on your bottom when you have wiped a million times :biggrin:

I went for my initial consult yesterday. Turns out I have a incarcerated umbilical hernia that can be repaired at the same time :redface: I am so excited about the whole thing. I have to go for a sleep study, and wear a CPAP for at least the 2 weeks before surgery. I also have to go on injectible blood thinners 5 days pre surgery (due to earlier blood clot in my lung). I just hope my insurance comes back with my preauthorization quickly:wink2:

Hello, I am from CO (orig from MI) and have my first consultation appt on the 9th of April. I have already been told by the doctors office that my insurance does cover bariatric services (she said my insurance is so good, she wished she had it.... I just hope she was not wrong about that :sneaky: I am looking forward to moving on to this new stage of my life. julie