boredryu

So I've been reading and posting for quite awhile now. I even went to the seminar back in march. But I never thought I would get approved for the surgery because of those 3 words..... "Documented Weight History" I haven't been to the doctor in years (I know, very bad) and every forum post I read talks about that in one way or another. To make a long story less long someone from my work told me she was approved without a weight history and so did a few other co-workers. I got the name of their doctor and gave him a call. The office clerk told me to fill out the application online and so I did. A few days passed and I called them because I didn't know what was next, it didn't give me an appointment date and the insurance worker told me that they get pre-approval first before initial consultation (to save time I guess) and she said once she knew she would give me a call. That was on Monday 4/14/08. 2 weeks passed and I completely forgot I even submitted the request for surgery. Anyway, I was checking my mail today and I got the approval letter! No weight history or appeal needed! I really think it had to do with my company policy. I work for a very big company and everyone from a level 1 employee to the president have the same healthcare plan. So I will give my insurance worker a call on Monday and see where we go from there. Talking to the people here the turn around is very quick. A few people had the blood work done on Thursday and the surgery on Monday so I'm hoping to have something similar. Anyway, I just wanted to share my story with you guys. If anyone in the DFW metroplex wants to know who the doctor is you can check out his webpage. Carter Lapband Take it easy, Boredryu! P.S. I have uhc choice plus!

Something amazing happened today while I was in the cafeteria at work. Someone from another dept who i've met through meetings and conferences saw me in line and we talked. She was getting buffalo wings and said "I shouldn't be eating this I've been banded". I asked her when she got banded and she said in feb 08. She also told me about a lot of other people who've been banded too. I asked her who she went to see and she said they all went to Dr. Richard Carter and how simple it was to get approved. Not one of them had to document a 5 year weight history, they just went in, had a really high bmi or a middle bmi and symptoms and were immediately approved. They all recommended him so I canceled my appointment with LBS and filled out an app with carterlapband.com. Anyway, I'm really excited!

I've posted a lot of single threads but I know see this thread is perfect for me. I have my initial visit on tuesday with AIG/Lap band Solutions. I have a 100 dollar yearly deductible (haven't been met) and a 10%/90% coinsurance. I called to see if AIG/lbs was in-network for uhc in dallas and the lady said "yes, but even if the doctor was out of network they charge in-network rates" Does that mean my surgeon could be out of network? The problem with that is it goes to a totally different scale (I think 40/60 coinsurance) with a much bigger yearly deductible. Luckily for me I have WLS included in my benefits and I won't let a little thing like a 5 year documented weight history stop me. I have a checkup listed for pre-diabetes symptoms back from 2004 and I couple things in between so I hope that will suffice. Anyway, Chris or anyone else still reading these things your advice with AIG/lbs or in general would be appreciated!

i have an appointment next week with aig, are they in-network for uhc?

get all the documentation you can. Then if they still deny you appeal the decision and a committee will review your request. If it's obvious you tried they'll have to approve you.

I'll keep my fingers crossed for you!

my company offers aetna and they seem to require the 3 month diet before surgery across the board (that's what the csr said anyway). Give them a ring, they are helpful.

I went to the free seminar and setup an appointment. I already knew my insurance company covered it but I didn't know all of the requirements. I called this morning to find out the only requirements are "medical necessity". I asked if there was anything else then they said no. She told me to be completely sure I should talk to their "care now coordination" (uhc) and so I did. The lady said she didn't know for my plan specifically but for all of uhc there is a 5 year medical history needed. That of course got me discouraged. Since I havent been to the doctor in years with the exception of for the dermatologist and my weight has never been recorded. What should I do? Your advice would be appreciated.

That's a very unfortunate situation. When your insurance companies denies you and self pay isn't an option it leads you with very little outs. Since they felt you were such a great candidate you may try and see if your surgeon can do it pro bono publico. That would dramatically reduce the costs. It's worth a shot.

Banded or not banded when you start exercising you have to start off slow. Let's say you're a male and you weigh 350lbs, even if you aren't banded it will be really difficult for you to start jogging right off the bat if you haven't been exercising consistently. I know a few people from football who can do this but they've been working out a long time. I would reccomend walking on a treadmill (less impact) and gradually moving to powerwalking. Once you are able to powerwalk for long periods of time you can give jogging a try. 3 months or 50 lbs is what I would reccomend to the 350lb male but only if he really really wanted to jog. Powerwalking will consistently keep his heart rate up and allow him to lose just as much as weight (if not more) than short bursts of jogging. Now once you get close or to your goal weight that's a different story.

when it comes to weightloss it can always be tricky. When I weighed 220 and lost 20 lbs. I still fit into my size 38 pair jeans. But when I went from 200 and below every 5 lbs I lost an inch off my paints size. I'm thinking it had to do with me stretching out most of my clothes and also when you start getting bigger they make clothes that "stretch". The George Foreman collection have clothes that even though it's listed at 48 you can wear it until 50-52. Hope that helps.

My insecurities may seem a little silly but I've never had surgery before and I just don't know what to expect. What happens the moment you arrive and until the moment you leave? Am I the only one embarrassed about my weight and afraid to get be nude in front of a group of strangers? Your input would greatly be appreciated.

My Company uses UHC, AETNA, and some smaller health care providers. They all have weight loss surgery in their packages. Aetna, however has the 3-6 month diet regimen. Luckily for me my provider is UHC. Which poses my next question. My surgery inpatient/outpatient coverage is 90% covered by uhc after deductible ($100) is met. Can anyone share from their experiences what the 10% cost to me will be? Will I have to pay up front or will my insurance company bill me? I am going through Lap-Band Solutions in Dallas so any advice you can offer definitely will help. I'll probably know for sure after my consultation but knowing a rough estimate sooner would be wonderful. Thanks