New Here

[chevy_truckin 0]

Hi all I am new here and really interested in getting the band and my wife is also debating on doing it too. Could any please tell me what the usual routine that they went through when they decided to get the band from the first dr app. To the day of surgery thanks

[babydumplin1968 13]

Welcome...I researched the process online first and found a local lap band surgeon. Registered for a consultation. Met with doc and nutritionist to discuss procedure, risks and benefits. Discussed insurance coverage and additional cost. Talked things over with family. Prayed!!! Received approval letter from insurance. Scheduled surgery, started pre-op diet (2 weeks before surgery). Registered at hospital and completed blood work and EKG. Had surgery, another 2 weeks of liquids. Then mushies, soft foods and on to solids. Didn't need a fill at second Dr visit. Whew..hope this helps.

[kiki2727 0]

Hi...I've been banded for 5 years now. The thing I didn't ask my doctor is what's going to happen to you after the surgery. It's a hard question and one that people think is an easy answer. U will struggle but if u chat to your doctor you'll feel a lot more relaxed about it.

[PattyGirl66 1,243]

Hi Chevy-Truckin,

Honestly, for me it was initially going to a seminar. Its very informative and you would be able to get to meet and speak to the surgeons afterwards and ask all the questions you want. Also, you will get to hear some stories of other weight loss receipients share their journey with you.

Now, first things first, always check with your insurance carrier to see if weight loss surgery is covered in your plan. What are the requirements, how much will your insurance pay? what are the guidelines? etc. Good to have all these questions written down before you call.

Once you are done gathering al that information, do some research of good reputable bariatric surgeons in your area and take it from there. (Make sure the surgeons and hospital where you are having the surgery is in your network).

No one really knows what is going to happen to you after surgery, no one. The surgeons can only give you a list of possible side effects, but believe me as you come on here and read, you will find many lapbanders experience different results. Some even as none. Everyone is different and it really varies. Just keep reading and you will learn. This is where I have gained all my knowledge about the lapband to be honest.

Good luck on your journey and I hope you keep us all posted on your progress

-Patty

[chevy_truckin 0]

Well looks like my journey ends here I called my insurance bcbs anthem and they told me they do not cover lap band at all and out of pocket is out of the question do if there isn't any other way looks like it won't be getting done

[Jim1967 3,569]

Well looks like my journey ends here I called my insurance bcbs anthem and they told me they do not cover lap band at all and out of pocket is out of the question do if there isn't any other way looks like it won't be getting done

I wouldn't give up so quickly. I have Cigna and when I called and asked about it they told me the same thing. I asked them for their written policy and low and behold they cover it if certain criteria was met and it was medically necessary.

I was banded in April after starting in October 2011. Cigna required a 6 month supervised diet.

[chevy_truckin 0]

I will certainly do that. I think I will also ask them why it's not covered when I know a person that had it done with the same insurance

[Jim1967 3,569]

Exactly!! I had a coworker who got the band a year before me and we didn't change insurance companies at work which is why I asked for the written policy. Insurance companies don't want to pay for the procedure if they don't have to and then they make you jump through hoops to get approved. Insurance company says this is in place to assure them that the person is serious and willing to make a commitment...personally I think it's all about the money.

Get more info out of them even if takes involving your HR Dept if you have one to advocate on your behalf. Remember you are the Customer and pay into it.

Good Luck!!

[bigenuff 302]

Well looks like my journey ends here I called my insurance bcbs anthem and they told me they do not cover lap band at all and out of pocket is out of the question do if there isn't any other way looks like it won't be getting done

I had a similar issue with healthnet but my dr was great.She wrote all the things I needed in the chart and told me how to get around being denied.i needed to write the director of the medical group and have them advocate for ne.She said several of her patients went that route.I ultimately ended up changing to PPO insurance at open enrollment so I didn't finish the process but there are ways around it.Good luck !

[chevy_truckin 0]

Well I called back and gave them hell asking why someone else with the same insurance got it done and this other person told me it was under the exclusion list but with a doctors written referral and the proper information it could be approved so now to find a good doctor in ky that would help advocate my situation I believe I'm a great candidate

[Jim1967 3,569]

Still make sure you get a copy of the coverage so you will know exactly what you need for approval. With this type of thing you cannot assume your Doctor will know the insurance guidelines. Insurance companies can be tricky.

To give you an idea of what I mean here is my insurance companies requirements::

CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:

• The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:
  
• a BMI (Body Mass Index) ≥ 40
  
• a BMI (Body Mass Index) 35–39.9 with at least one clinically significant obesity-related comorbidity, including but not limited to the following:
  
• mechanical arthropathy in a weight-bearing joint
  
• type 2 diabetes mellitus
  
• poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management)
  
• hyperlipidemia
  
• coronary artery disease
  
• lower extremity lymphatic or venous obstruction
  
• obstructive sleep apnea
  
• pulmonary hypertension
  

• Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components:

• weight
  
• current dietary program
  
• physical activity (e.g., exercise program)
  

Programs such as Weight Watchers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

Thorough multidisciplinary evaluation within the previous 12 months which includes the following:

• an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes
  
• a separate medical evaluation from a physician other than the surgeon recommending surgery, that includes a medical clearance for bariatric surgery
  
• unequivocal clearance for bariatric surgery by a mental health provider
  
• a nutritional evaluation by a physician or registered dietician
  

[chevy_truckin 0]

Ok will the insurance company just agree to send it out or will they try to tell me they can't? Also just ask for my complete detailed coverage or just bariatric

[Jim1967 3,569]

They should. Just call them and ask them if they can send you a copy of the gastric banding coverage guidelines. Rep at Cigna emailed me my copy.