tennleslie1

Okay, so I had my consult with dr. yesterday, and he said that because of my diabetes that HE WOULD approve me for the surgery. My BMI was 34.6.. grrr... anyhoot. The nurse told me that my insurance required a 5 year weight history report. So, I have to go to my drs. that I've seen in the past 5 yrs and get how much I weighed. My question is this... how many reports will they need during thos 5 yrs. Like, is there a certain amount of times during those 5 yrs that I should have been weighed when I went to the dr.? Does this question make sense? I think I am confusing myself now... so sorry. Thanks anyway!!

my insurance requires 5 yr weight loss documentation. i have to get my weights from drs. from the past 5 yrs. then, i'll have to do the 6 month weight loss thing...ugh... i'm just getting started and already i want to pull out my hair! lol

Greetings from Knoxville, TN!! I'm never really sure what to put about me in the sections of forums that ask "about me". Let's start from the beginning. I'm 30 yrs old, I will turn 31 on February 1. I have been married to my high school sweet heart for 10 yrs this past June. We live in Knoxville and have 0 children. In 1997 I was diagnosed with Type 2 diabetes. I should have seen it coming considering my mom had it and now my dad has since been diagnosed with it. Luckily, they are able to control theirs. All of my life I was (and still am) the "pretty, lil' chubby girl". That was okay until I learned it wasn't that great of a compliment. I have been looking at the lap band for a few years now, but only found out recently that our insurance now covers it (they hadn't in the past because the procedure is reversable). Having found out otherwise I am now thrilled with the possibility of having the surgery and becoming healthy. Like I said, I am 30 yrs old and have a BMI of 34.9 I am tired of being unhealthy. I want to start living my life and I want to do it by feeling healthy. Jan. 13, my husband and I will attend a seminar given by a Dr. here in town who will discuss the pros/cons of the surgery and how to "get the ball rolling" so to speak. I have no idea what to expect or even where to begin. If anyone could suggest a Dr. that they know of in this area I would greatly appreciate it. Like I said, I have no idea where to begin so I checked out one of the hospitals here and found his name. He is the head of Bariatric Surgery but in this day and time, titles do not necessarily mean anything. Any help you guys could offer would be much appreciated.

Hey Stephany, After much research and talking with folks, I have narrowed down my choice for surgeons (if insurance will approve me). Feb. 2, I see Lynn Moreland of Dr. Mancini's group at UT and then on the 6th, I'm going to head over and see what Dr. Ray at Blount Mem. has to say. I really think that I'm going to like Dr. Mancini from what I've heard. Is his office staff pretty good about helping you get your insurance approval? Best of Luck to ya!!

Okay, so I went to another seminar last night held by a different doctor and was really impressed by the presentation and the information given about the program. The good thing is that their fee isn't the outrageously high $3000.00 as the others. This program fee is $750. Which is so much fore doable than the $3000.00 Honestly, I felt more like a Dollar sign than a human being at the previous seminar! Be a good doctor, be a great doctor! But don't charge patients an arm and a leg just to prove it! Anyway, after the presentation, I spoke with the coordinator and scheduled my consult visit. February 12. 2009... this could possibly turn out to be the best Valentine Day gift I could ever hope to receive!! Wish me luck!

Hey Guys! Thanks so much for the well wishes. The seminars are free..at least both that I attended. The program fee for the $3000 includes: (as listed in my info. packet) *oversight of your bariatric behavior modification program (still not sure what that is exactly!) *coordinating services related to your surgery *24 Hour bariatric hotline answered by a registered nurse with special bariatric training *diet education by a registered dietician *exercise retraining initiated through consultations with an exercise physiologist * follow up visits pertaining to weight loss surgery for the first 12 months The $750 program includes: (as per the packet I received) *nutrition consults *exercise consults *3 month wellness center memebership *monthly support groups (although I didn't know one had to pay for support groups....do they??) *pre-op education classes *post op nutrition classes *insurance and financial counseling *testing and counseling coordination *assistance with medical record obtainment *30 day supply of post op vitamins Now, I could be wrong, but aren't those programs similar? Maybe I was just offended in thinking that the first set of doctors were bold enough to think that any and everyone has $3000 just lying around in their cushions. Thanks again for the well wishes!

Well, I went to my seminar last night and even picked up my information packet. I'm ready to get the ball rolling. The only thing that downs my hope is their program fee. $3,000.00 Yes, allow me to spell that so there is no confusion (three THOUSAND dollars). Is that normal?? And what about the "consult" price. $300 just to see if they will even do the procedure. Is that refundable if they or the insurance says no to my surgery? And while I'm at it, let me just rant about the information packet. It is truly a pack that only college graduates can understand. There are words in there that I have no idea what they are or what they mean or even if they are English!! Do you think it's possible that if I were to call the nurse that they would sit down and help me fill out my packet. It has to be completed before my consult. I'm just barely out of the gate and already I feel defeated. Help!

This is from the packet I received: Fees for Gastic Bypass with Insurance. *Initial Consultation $300.00 This fee must be paid by you on arrival for your consultation but may be reimbursed by your insurance in which case you will recieve a refund. *Surgical Weight Loss Program $3,000.00 This fee is covered by SOME insurance carriers (mine isn't one of them) It includes: 1. Oversight of your Bariatric behavior modification program 2. Coordination services related to your surgery 3. 24 HOUR Bariatric Hotline answered by registered nurses with special bariatric training. 4. Diet education by a registered dietician. 5.Exercise retraining initiated through consultations with an Exercise Physiologist 6.Follow-up visits pertaining to weight loss surgery for the first 12 months. It's pretty much the same for LAP BAND only adding Access to secure website information about my case. (What the Heck is that?!) I know that one dr. in the area charges $500.00 for a program fee but I don't want to do more harm than good just by trying to save as much money as I can. I know that my health is nothing to play with, but if the other dr. performs the exact same procedure and has the same program, am I just paying for the name??

Well, according a nurse that I spoke with this morning, I'm overweight but not enough. I had checked my BMI with a chart/calendar online and it said that my BMI was 34.9... our insurance requires 35 with 2 comorbidities. I have those and with my 34.9 I figured I was a sure in. Well, according to this nurse, my BMI is 33.8 I rechecked and sure enough, she was right. Dang! So hubby did some checking and found out that I would need to gain 7lbs. but to be on the safe side (not knowing if their scales would be off or not) I should gain 10 lbs. I'm at a loss. I want to LOSE weight not GAIN it, besides, if I knew how I gained it, I wouldn't have to lose it!! How in the world does someone go about putting on 10 lbs when I'm already miserable enough! 10 lbs is all I need in order to be approved.....GAH!!! UGH!! Any ideas, anyone???:thumbup::wink_smile:

Thanks for the suggstions about the books. I wonder if Barnes & Noble has them?? Never hurts to check it out and see. Thanks again. BG, you are absolutely hilarious. You have awesome writing skills. Thanks for the laughs!

Hmmm... I'm liking the idea about taping quarters to my body...lol...wonder how many quaters it would take to gain say...10lbs (just to be on the safe side in case their scales differ from mine??) Oh how I wish I had someone to hold my hand and do all of this for me... the appt. making and what not. I have absolutely no idea what to do first or last or what. All I do know is that I go to a seminar on the 13th...after that I have no idea what to do next. I'm not sure how to find the best surgeon and especially one that one won't break me on the program fees or does insurance cover that? Can anyone direct me to a "Lap Band for Dummies" book? LOL HELP!!

Okay, seriously, you gals are a riot! ROFL.... I gotta tell ya, each of ya have some really great ideas! I wonder how the weights in the bra would work considering that's the only part of my body that actually needs some weight?!?! I received some other suggestions about possible diver weights... hmmm.. slap the belt of that bad boy around my waist and I'm good to go. My question would be this.... what happens if I "lose" the weight right before surgery?? Surely I can't wear the diver belt and my weighted bra into the operation room...or can I?! Hmmm... and secondly, how long does the process usually take? From first dr. appt. to surgery? I'm still in the early learning stages. Thanks so much!

Thank you guys so much for the replys and suggestions. I think perhaps I am on the verge of becoming obsessed about this whole thing. I am now having dreams about it! LOL... hmm.. wonder if that's a good thing or a bad thing. At any rate, I have to do something. Ya know, sometimes I wish the insurance people who had the fate of my health in their hands could spend a day going through what I/we do. I am absolutely certain they would approve any and everyone on the spot. I even suspect they may OFFER the surgery!!! I think my next step is to maybe call the insurance and explain to them my situations. My only problem is will they actually take time to LISTEN to me, rather than just hear me. Thanks again!! Best of Luck!

I called our insurance last week and asked if they could send me some information about the surgery. Here is part of the letter that I received. It didn't, however, mention anything about a BMI so, I'm lost... *********************** In order to complete our review if benefits are available, we need additional information. Please refer to the list below and provde us wtht he items indicated so that we can complete our review. * History & Physical including Height, weight with co-morbidities *Initial Evaluation *Documented 5 years History of Morbid Obesity *Documented failure of 6 months of medically supervised non-surgical methods of weight reduction by either MD, DO, Nurse Practioner which includes nutrition therapy, behavior modifying exercise or increase in activity, medication therapy or mantenance therapy *Psychological Evaluation *Documentation of willingness to comply with the pre operative and post operative treatment plans *Documentation of Procedures to be performed along with codes *Is procedure being done short/long limb and how many centimenters and length. After receiving this information, we will conduct an additional review to determine if benefits are available. Sincerely, Customer Advocate ************************ So, who knows.....I know that nothing worth doing happens all that easily, so I'll just continue saying my prayers each day. Surly God hears a good ole' country girl in Tennessee!!

Hmmm.... sounds simple enough. Me thinks that shall be numero uno tomorrow morning! Thanks Steelers!! Seems like somewhere I read something about BMI being 32, someplace else it was 35 and like you, I also read 40. Do certain comorbs play a part in it? I'm Type 2 Diabetes, I have been for going on 11 yrs, high blood pressure, family history of heart disease and myself I have A-fib. Just wondering... you guys are absolute jewels for answering my questions, thanks so much!!!

Thank you both so much. Do you guys happen to know if BMI differs from insurance to insurance or is it the same straight across the line? Honestly, I'm afraid of getting my hopes up. I'm running out of options.......and hope. Thanks.