I have been thinking about getting banded for a little over a year now, but have only recently started taking the steps toward doing so. I just attended a seminar after months of research, I understand the process fairly well...but its the steps to get there that Im confused about...

Do I talk to my PCP now about it, find a surgeon and then go to me PCP? Who contacts my insurance about it all... I guess its the starting that has me in a rut...help

I started out by calling my insurance company to see if it was covered. They said it was and I didn't need a referral so I made an appointment with the surgeon's office at that point.

I'd call your insurance first and ask them if it's covered.

Good Luck!!

Thank you, I did call, they said they only covered it if its medically necessary, so I guess I have to see my family doctor and get him to write it off and see a surgeon. Im really scared about it though, because he is an old-fashioned doctor...but I have had him since i was a baby so maybe he will be more understanding since he knows my weight battle?

Thank you again, and best of wishes for you.

After I was told it was covered by my insurance company, I attended a seminar given by a bariatric surgeon at the hospital where I wanted to go (both the hospital and the Dr. were in-network.)

At the seminar, they gave me a large packet to fill out and instructed me to return the packet to the surgeon and make an appointment with my PCP to get a letter of medical necessity (the surgeon provided the form they wanted my PCP to fill out.)

I worked with both the surgeon and my PCP at at the same time, so you might want to contact whomever did your seminar and ask them to walk you through the best way to proceed.

kagead

Thank you, I did call, they said they only covered it if its medically necessary, so I guess I have to see my family doctor and get him to write it off and see a surgeon. Im really scared about it though, because he is an old-fashioned doctor...but I have had him since i was a baby so maybe he will be more understanding since he knows my weight battle?

Thank you again, and best of wishes for you.

It doesn't really matter what your doctor says. The insurance companies determine if it is medically necessary or not based on your BMI.

You need a BMI of over 40, or over 35 with weight related health problems.

You can calculate your BMI here.

I am also new to the process. I am also wondering where to start. It seems like there is such a long process. One of my bigger concerns is the cost and whether my insurance will cover it. If they don't, I'm not sure I'll be able to afford a large out-of-pocket cost at this time. This is stressing me out alot. I'm also afraid that I'll run into someone trying to lead me in a different direction. I'm not too familiar with my regular doctor, so I don't really know what her feelings are on this type of surgery.

Ok, I think I've made up my mind: I'll call my insurance and talk with them and get recommendations on where to go from there. I'll do this tomorrow.

Good luck to those who are going through this same process and are feeling overwhelmed. Hopefully we can stick together and help eachother out through these times!

I am 20 years old and did just what you did. haha. I actually went to my Dr. first (whom I am not super familiar with) and told him I was interested in the surgery for my health and we discussed my weight issues over the years. From there I called my insurance and asked what the requirements were and they told me they could not release that information?!?!?!

They DID tell me though, that I need a prior authorization from my Dr. I called the facility that I know my insurance covers and tried to get an appointment...or a date...to go to a seminar and am waiting for a call back from a nurse there to set up a consult with a surgeon. I have yet to recieve a phone call. Since you're just starting out like I am, and I am anxious as it seems you are, too; I think it would be great to message every so often and maybe give each other advice on what next step we took!?!

What do you think? message me!

-Danika

I am also new to all of this and I think it would be great if we kept each other informed. I live in Birmingham, Alabama and I too have a doctor that is new to me but my friend has used her for years so i know that she is supporter of the Bariactric procedures. I have also attended a seminar and I chose a surgeon at the hospital where I work. I know that my insurance BC/BS Alabama Preferred covers the procedure but I am going to have to do a 6 month supervised diet. Other than that...keep the info coming and we can all go through this process together.

For me, I knew it could be covered if medically necessary (and it is for me), plus I've spoken to my PCP about it at a regular visit (and later verified this over the phone) and she said because of some conditions I have, I would have an extremely hard time losing any weight. She said she would recommend me for the lapband.

I now just have to complete required pysch eval, along with nutritional consult, ekg and pulmonary function test. The good thing is that I'm getting to do all these on the same day. Good luck.

i had orig approached my dr like 8yrs ago w/the idea. that dr was not pro-surgery. this year, i reapproached the idea, new dr/insurance included.

i went to the seminar. got the packet. i called my insurance(who i work for ) and found out that yes, if medically necessary its covered 100%. for those that have BCBS-usually this means in terms of weight: your bmi is 40+, or 35+ w/at least 2 co-morbidities(hypertension, diabeties, sleep apea, high cholestrol, etc).

i started meeting w/my dr to discuss wt for 2mo (then realized i had proof of my 3months attempt w/WW already). i met w/the surgeon for consult. she did an ekg/lung test that same day(passed). i met w/the psych consult(*NOTE* PLEASE MAKE SURE PER YOUR INSURANCE-WHO IS APPROVED FOR THIS EX. LICENSED PROFESSIONAL COUNSELOR, PSYCHOLOGIST, OR PSYCHIATRIST, as your insurance may deny/delay your request due to not meeting their policy)...once i met w/the psychologist, all my paper work was s ubmitted. and approved. i knew w/in a week. i met w/the dietician on the 28th of june, as well as the NP for the preop visit.

the key to the process is staying informed, educated, and communicating w/all parties. make sure all your visits are authorized and submitted for accordingly (ie. psych, dietary).

i started my preop diet today(2 weeks til my B-day)-makes sense banding day and new me day...it can be overwhelming, but only if u let it.

I am going to put out a word of caution here: Every insurance POLICY (yes, policy, NOT company) is different as is every surgical practice. We all do the best we can to help each other here (which is fantastic!) but everything needs to be taken with a grain of salt since there are sooooo many variables.

My best advice to everyone starting out is to contact your insurance company first. Almost all of them will say the surgery must be "medically necessary" and will then give you the list of requirements they have. Minimum BMI, required supervised diet time (3 mos, 6 mos. etc.), allowable co-morbidities if minimum BMI is not met (sleep apnea, hypertension, etc.) psych evaluation and other medical tests.

Then, ask them to give you a list of approved bariatric surgeons and facilities in your area so you can be sure you are going to someone in-network. Most insurance companies also have a providers list online so you can look up surgeons that way. (My surgeon is a gastro guy who specializes in bariatric surgery, so be sure to look up both specialties.) Then, call those surgeons and attend their seminars. Ask each surgeon what their individual process is in regards to testing, nutritionist visits and the like.

From my experience, and what I have learned reading this forum for the past 8 months, the bigger and better practices will walk you through everything so you aren't trying to figure it out on your own. They will advise you of what you need to get from your PCP as well. My surgeon had a form that my PCP needed to sign. It said that she not only supported my decision to have WLS, it also said that she would continue to treat me after the surgery. That went into my file that was submitted for insurance approval.

Good luck to everyone. Be patient as the process can take a long time. Remember to be your own best advocate, no matter how much you trust your Dr. Nobody will be looking out for your own best interest more than you will. If you are not getting the information and answers you need from one practice, look for another. If the insurance company is dragging their feet, be aggressive about calling back and getting the answers you need.

kagead

Every surgeon's office is a little different, but I think the surgeon is a good place to start.

At my first seminar, I was able to provide my insurance information; the insurance specialist in my surgeon's office notified me within a couple of days of my coverage.

(I had already read my insurance policy, so I knew it was covered, but it was nice to hear this "officially.")

My PCP was not a player in the process at all. Some insurance companies require referral, but mine did not.

So I just moved from the seminar to scheduling a consult with the surgeon. From there, it was all kind of formulaic; they spelled out the steps I had to take, I did what they said, and after 3 months (as required by my insurance), I was cleared for surgery.

If you can lay hands on your policy, it's a great place to start. Otherwise, I'd let the surgeon's office do that legwork for you. They will let you know what specific requirements you have to meet.

Good luck!

i am 20 years old, and the first thing i did was go to the surgeon and set up a console, he then found out for me if i would be approved and met the requirements, their office basically did everything for me, except for getting all the tests done lol but im getting banded in 8 days and im soooo excited!!

good luck to all of you, and do make sure your surgeon is on network..also get a sleep apnea test done..thats what got me approved!!

Well, I talked to one of the nurses at the seminar I had attened (I live in Lebanon PA, and the closest seminar is in York, so its not under my covered insurance...but I cant seem to find a seminar for the Surgeon I would like to go to, who is covered, and ALOT closer to home. Dr. Currie, if anyone has had him or knows anything like my situationt hat could help me, I would be forever grateful!!) but the nurse was very nice, and they cant take me there because Im not covered. So, I need to find one my insurance covers, but cant seem to find any....

Are there other sites to go to to find seminar listings other than on here? (I also cheked the Surgeons site, and there wasnt on there, and I looked at the hospital where it would be done, and still found nothing)

I found the seminars were listed by the hospital, not individual surgeons. I just started looking at well known hospitals in my area.

Since you still seem to be having trouble finding a surgeon on your plan, I am going to re-suggest you start with your insurance company. They will have a list of Drs. who are all on your plan. That part of the process is no different than it would be if you were searching for a PCP, an OB-GYN, etc. They have a provider listing for you. It might even be available online.

Good luck to you-

kagead