ocbreeze4u

My insurance required Doctor Supervised Diet with monthly weigh-ins, nutritional education and behavioral modification...all had to be documented monthly in my patient file. I had to do this for at least 6 month in the last two years and I did. BTW, my insurance is Aetna PPO.

Congratulations! I am having my surgery two day later on July 17th and I have 97 to lose :smile2:

If you call your insurance, they will tell you if you are covered for Lap Band and they will also tell you their criteria. I work in the healthcare industry and I did some research. They do cover it (unless your employer excluded it which is highly unlikely) and what you need is letter of intent that includes your current BMI, Nutritional Consult and Psych Evaluation. It is best to see the group you have chosen to have your surgery with (make sure they are on your provider list in your network) then they will arrange for all your evaluations and submitt your letter of intent for pre approval for you.

One easy way is got to Photo Bucket (photobucket.com) and you can join for free. You download the photos you want to share there then it will convert them to code for you. You cut and paste that code on to your signature here and wa-la! Just make sure when you download to photo bucket that you make it a smaller size or when you paste it here it will be visually huge. As for tickers, you can go to tickerfactory.com and set up a ticker you like there...it is easy and they walk you through it. Same as photo bucket, you get the code at the end to cut and paste in your signature then you are done. I hope this helps.

Long to be Free, Mine will be outpatient as well, thank goodness. I grew up in the Palm Springs area and when I graduated high school I moved to O.C. and never moved back. We are now Orange County Transplants like most in Corona now...lol ! (hense my screen name OC Breeze) I miss OC very much, you are lucky. Where are you having your surgery at? As for the staph infection, did she acutally take a skin sample or are they just assuming?

Me personally...I think B Vitamin Shots are a farce! I was on a doctor supervised diet for over a year and a half (went off of it in Feb 08) and for over a year I did the B Vitamin shots and the last few months I did not. Did not improve my energy nor did I lose more weight with it compared to without. That is just my personal experience.

I do not know much about Pacific Care, are you PPO or HMO? If you are HMO then you need to go throught your PCP/Gate Keeper. If you are PPO then chances are you can just be a self referral. With my experience I thought it was best to do a Surgeon Consult first as they are very experienced with what EXACTLY you need per your insurance to get approval. I have Aetna PPO and I did that and I am glad I did. Although I had to go through two appeals it was worth it (I am on the low end of the BMI chart).

I am confused, I see two separate lists on this thread by two different posters....hummmm....well, please add me to your lists:confused2: My date is happily July 17th:w00t:

Some insurances accept sleep apnea as a co-morbidity but all accept diabetes as a co-morbidity (but not pre-diabetes). I only have a BMI of 36.9 however, I am diabetic so I qualified with Aetna PPO. There are ways of increasing your sugar levels during a 4 hour blood test so you will come across as diabetic...if you are interested then send me a private message and I will tell you how:wink2:.

Thank you for the well wishes and we also have something else in common...I grew up in Palm Springs, acutally Rancho Mirage but I went to school at Palm Springs High School. Duh! Everyone went there in the 80's, it was the ONLY high school for 5 cities back then...lol ! I have 97 lbs to lose so I hope I am like many here that lose the first 100 in one year however I think my first 50-70 will be easy and the last 30 lbs will be a struggle....ahhhhhhhh!!!!!!!!!!!!!!!!!

I have been open with everyone about my up coming surgery, including my family (and husband's family) and all of my friends. Keep in mind that I am the only fat one out of everyone that I know with the exception of one friend that is looking into it. In my circle, everyone has been very supportive so I am lucky.

I am July 17th too!!!

Christine, thank you for the information. I am trying to create a shopping list and what the docs tell you to get and what you actually need are two different worlds. You you can think of anything else, please let me know. I too had a struggle with my insurance, but not as long as yours. Since January I have gone through two appeals and I finally got the decision from Aetna over turned mid June so my surgery is scheduled July 17, YIPPY!!!!

What will I miss??? I will miss having a smooth wrinkle free face. I am turning 40 this year and I look much younger (The photo on my profile is a current one) and I think it is due to having a chubby face...the fat fills the wrinkles. I know when I start losing weight I will quickly have wrinkles come out of no where! Thank goodness I am a full believer that we should grow older gracefully, I just do not want to look old so I am swear by plastic surgery :thumbup:

I am also borderline, I am 222 with a BMI of 36. In the surgery group I am with I DO NOT have to do a pre diet, I DO NOT have to do more than 2 physical appointments with their office outside of the seminar and I got my letter of approval in the mail on June 16 and my surgery is now scheduled for July 17. UCSD is a university medical center and they are more into teaching than the patients so you will need to jump through many hoops to get your surgery. If you are willing to drive to Beverly Hills, I have a great surgeon for you:wink2: but I am sure you will be able to find one local to you that will treat you on an individual level. Do some shopping around.

Hello! My surgery is approacing on July 17. I have a list from the doctor's office on what to eat and such however, I would like to hear suggestions on what I will need to get through my first week (ie, broth, popsicles etc) after surgery so I will not need to leave the house or ask my dear husband to run to the store as his plate will be full with working and then coming home and taking care of our three girls? Please share your wisdom:)

I'm with you, mine is July 17!!! Congratulations:thumbup:

Welcome! Who is your insurance carrier?

Hello to all out there! For anyone whom is interested, my Lap Band surgery date has been moved up from July 24 to July 17, 2008 YES!!! I have to go in on July 10 for my pre-op consult and after care instructions so this is it, 21 days until my Band Date.

Maybe I am confident due to I have seriously looked at this for over 3 years and I actually personally know 3 people that have had this done, one had 220 lbs. to lose and two years later she is only 20 lbs away from her target weight of 145!!! I can do this and I have 97 lbs to lose...You can do this! It will take some hard work on your part and hefty payments over the next 5 years (wink) but your health and longevity is worth it. Good luck to you!

That is the hard part as Aetna gives you the run-around everytime you call. Call the customer service number on your membership card and ask that you speak with the nurse reviewing your procedure request for Lapband. If you are lucky, the representative on the phone will know what they are doing, if not then they will transfer you about three times. If that happens then ask for their supervisor and tell her what you need. Once you get the nurse (you will get her voicemail) make sure you get her extension number with first and last name so you will not have to fight with customer service the next time you call and leave her a message to return your call because you have a few questions. Make a list of what you need to know such as.. Am I missing any needed documentation? Do I meet the qualification per your guidelines if not then what have I not met? If you did not meet any criteria or they need some more information, ask if she will grant you 14 day wait to obtain the requested. They will and that will give you time to gather what you need instead of going through an appeal or a peer to peer review. I had problems with my doctor's office handling my appeals as they screwed it up so my second appeal I handled all myself and told them (the doctors office) to bug out of it. I won in the end and I can honestly say the Aetna is very tough to deal with and I am in the healthcare industry! Good luck and if I can help you in any way then please send me a private message and I will walk you through it.

Linksmom-You are my twin but I still do not get the liquid diet thing that I read everyone has to do??? My doctor nor my insurance does not require it but I do have to be on liquids 48 hours prior and on an empty stomach 12 hours before surgery.

Hi Polly522 LOL, very funny. I have learned this...it is good to find out whom your nurse reviewer is and give her a call and do what it takes to give her a great impression of you. I was going to be approved the first them and I talked with the nurse that was reviewing my case. The day before she was to sign off she went on leave from Aetna and a nurse taking her cases was to sign off on it but instead she rejected it. I talked with the original nurse after the fact and she was frustrated as well because she approved it. Please remember that Aetna automatically rejects 80% of all claims for Lapband originally but almost always approves on peer to peer reviews and appeals so be patient....it will happen. After two appeals I was approved on June 11 and I got my letter in the mail last Friday and my surgery is scheduled for July 24. Good luck!

I knew about the 2 years of a high BMI and I did not have to do a psych evaluation but I also did not need to have a pre-diet. Other than the two appeals regarding my BMI dropping below 35 BMI in the last year (it only dropped .04% to 34.6 BMI) and I was below by only ONE POUND, I did not have to "jump through hoop" as I have heard from some. Maybe it depends on the nurse reviewing each individual case at Aetna or maybe it was because I was already on a Doctor supervied diet at the time my case was submitted to Aetna? Well, at least this comfirms what I have always known that Aetna is NEVER consistant and you just need to know who to brown nose over there to get what you want:sneaky: LOL

I would really like to help you with your problem but I need more information such as what is your BMI? Do you have any health problems?