Cloteal

Thank you for giving me that info, I called the Psych Dr. that I'm scheduled to see as I was told that I may not be able to go outside of Duke (left a msg for her to return my call). Oh yea by the way, HAPPY BELATED BIRTHDAY TO YOU (imagine me singing this)haha. Talk to ya later.

Can you please provide me with her (Psych) name and number. I chose Duke because it was recommended based on the fact that I was borderline BMI. I first was going to Dr. Mitchell in Pinehurst, I couldn't even get an consult with him as his insurance specialist bluntley stated in so many words that I don't qualify. This happened to someone else and they went to Duke and was approved, and they referred me to Duke.

Thanks Skep, and I should say congrats to you on your weight loss. You should be proud that you lost 35 pounds , that is a big accomplishment. Keep up the good work.

I live in Fayetteville, but I work in Raleigh. I wonder if I can find my own Psych Dr., or do I have to use one of theirs. Thanks for this information. When were you banded?

Ok, I finally received a call on Friday from Duke to schedule an appt with the surgeon. My first appt is 06/15 with the surgeon, Dr. Sudan, then on 06/30 I see the Psych Dr, I was told I would need $300.00 for this visit (out of network psychs), and when I go again the second visit with the Psych Dr I will need to pay $250.00, which will be reinbursed once I file with my insurance. The Rep that called me said it would be reinbursed, she didn't say at what percentage though, but I spoke with my insurance co BCBS of NC and I believe it will be at 80%.

Hi Lisa and thanks for your comment it was very helpful. I called my insurance co and yes, you have to meet the coinsurance deductible, plus your outpatient deductible, and they will pay 80% of total bill if your coinsurance has not been met. After all your deductibles have been met they would then pay 100%. That's the way they explained it to me, I was just concerned that I was going to have to pay up front, but Duke said that they wouldn't know how much I would have to pay until I actually had the surgery and they billed my insurance. Did you have to pay for the psych eval or anything else up front?

Hi Skep, it's me again, I was told on yesterday by someone who was going through BCBS of NC that her out of pocket fees were going to be anywhere between $2000-$3000. She wasn't going to Duke it was another Surgeon in NC though. I just want to make sure when I go for my appt, that I'm still waiting for that they don't tell me this. I'm prepared to pay for the psych eval. Just need some assurance. Thanks

Can't wait anylonger, did you get your June surgery date?

Wow, this question was an eye opener. I haven't been banded yet, in the process of being banded but never did I think about the scars and that there's going to be an object inside of me that you can actually feel just by rubbing the outside. I to am married and I don't believe any of this will be an issue for my husband, but for me it was kind of a scary thought that the scars could be that huge and noticeable. How big will the scar be?

Thank you for that info. If the process goes fast for me I will be ready. I'll keep you posted on my approval etc. Keep up the good work with your weight loss, looks good. Oh, one more thing, did you have to pay for the psych eval up front and what else did you have to pay for up front if any? My insurance co will pay 100% in network, out of network 80%, which Duke Psych Dr's are out of network. So I have to pay $350 upfront for the psych eval.

I wouldn't get discouraged, there was a time when my insurance company BCBS of NC didn't cover weightloss surgery, now they do. Just hope for the best, whether it be now or later. Something will come through for you just have faith.

Congrats to you. I hope you get your June surgery date, keep us posted. Yes, I did contact my insurance co which is BCBS of NC, I do meet the requirements as long as my BMI is 40, which it is. I'm going through Duke Medical Weightloss Center, as I heard they were really great (a center of excellence) and they have been good with making sure you have everything thats needed for approval. Being that they are a center of excellence they have many applicants and it will take atleast 4 weeks to even get an appt with the surgeon. But I'll keep you all posted. I know there will be someone like me who will want to know the procedure, how long it takes and what next, so I will be there for them to. Thanks so much for your post, it was really relieving to know that BCBS does not take long for approval.

I'm not an expert or anything, but what type of insurance do you have? And may I ask why you were denied? You can appeal the decision. Find out what your insurance company require and go from there, it may be something simple that they denied you for. Get a copy of your insurance policy.

Ok, I went to the orientation on yesterday. Received application packet, completed mine already and faxed a copy to them today and mailed the original today. Lets see how long it takes to get an appt with the surgeon. I was told yesterday that it'll probably be 4-6 weeks before we receive a call for an appt. (WOW!!!) I'll keep you all updated.

Just wanted to know if you knew the process there, about how long everything will take. I went to the orientation today and will turn my application in on tomorrow. Then what shall I expect? I was a little confused today, I have BCBS of North Carolina and I was told in the meeting today that they don't BCBS ask for a 5 year weight plan, nor a Dr's recommendation, all you need is a BMI of atleast 40. Maybe I misunderstood them. Help me understand.:thumbup:

Hey Guys, I have an update. I received a call earlier today from Duke, they had a cancellation for tomorrow for the orientation, we'll see what happens from there on. Pray for me that I don't get a airhead for the insurance specialist.

Thanks. I know that my insurance covers lapbands with a bmi of 40+ and less than 50. I printed out the policy, and I have a friend who has bcbs of NC and had this procedure done. That's who recommended me. Do you have a surgery date set yet? Good luck to you and I wish you wll.

You know what make it so funny, she didn't even have any of my info yet. She based it on my height and weight only. She hadn't even received the letter of recommendation from my Dr. All she said was at the time of orientation when I weighed in I was only at a 39.8 BMI. I knew right then that I wasn't gonna let her mess my paperwork up.

Hi Skep, I found out where to go at Duke, I have my orientation on May 29th. Hopefull things will go well. Thanks for the advise.

Can you please provide me with Duke information. How do I get information on the next orientation that is scheduled. I think this will be the way for me to go. I just got a email from the Surgeons office, I guess the one who is responsible for getting my information together and submitting it to the insurance co. Well, she told me straight out that I wouldn't qualify because my BMI was below 40, it was actually a 39. something. I emailed her back and told her that was incorrect info as they had my height entered wrong. I just know it's going to be some mess, so I'd rather not deal with them. What you think? I need some advise. Oh, by the way my Doctor wrote a letter of recommendation stating that my BMI is a 40+.

Congrats first of all on your weight loss. I appreciate all the info you've given me thus far, it is very conforting. I will have a plan B ready. I now feel so confident that I'll get approved. I have my packet just about ready, I'm just waiting on one more test (bone density). I have that scheduled for 05/14, then on 05/27 I go before the Surgeon to discuss this whole ideal. Hopefully the process won't be too long. I'm really hoping for a July surgery date.

Thanks for that info. Was your BMI close to being under 40, and did you have any other medical problems?

UPDATE................. Ok all, I finally went to my first appt with my PP. I would say it went rather well, I was sort of worried about my BMI being too low, but I hit that 40 on the head. I got my blood work all done today, I'm waiting for an appt for a bone density test, which is required for women my age. My PP talked a good game today, she was all for me having this done, she said once the results are all back she will have the letter prepared and ready to send to my surgeon. I am sooooooo excited! Pray that my insurance BCBS of NC will approve me on the first go round. I am ready to lose all this extra weight. I'm ready for a new start. I'll keep you all updated with the progress, how long it's taking etc. Thanks for all your support and keep me in prayer.

Did you have any major medical problems that helped the approval process? Congrats on your weight loss thus far. Keep it up.