I Called TRICARE Prime today and sure enough Dr. J is out of network. So I had them call Dr. Adam Smith to see if he was in network and took TRICARE Prime and he is in network. I was Happy to hear that after all the stuff with Dr. J.

I called my primary care dr. and talked to the nurse and she is going to send my referral to him on Monday and give me a call after lunch to let me know when the next seminar is. She said the seminar is requierd so I am slowly getting there. What exactly goes on at the seminar? Does anyone know how fast the process is after the seminar for Dr. Smith is before your able to get the process on the road for the surgery?

Tammy

I don't know any particulars, but most docs require you to see a psychologist (my advice, locate your own if they'll allow it) and a nutritionist/dietician. Some require other testing according to your co-morbidities. I hear Dr Smith is a great guy! All in all, it usually goes pretty quickly once your insurance has approved the surgery. It takes longest to get the Dr visits and insurance approval. Good luck with that! Congrats on finding someone!

I would advise you to call your insurance comp. and ask them about the time limit.

Im not sure about YOUR insurance company, but mine was wonderful to work with. I called my ins. comp. nearly DAILY to get up-dates as to if they recieved a fax or if they were waiting for something else that was needed for me to gain approval.

In most cases, the ins. company is what makes everything so slow.

Good luck!

Best of luck to you, Tammy! Be patient! You didn't get this way overnight and you may have to jump through some insurance hoops to get your band. You want to be sure and do everything the right way so they won't deny payment. But it is definitely worth it!!

I know it will take some time before everything is set for the surgery but I am just happy that the refferal is being sent. How often do you have to see the psychologist and nutritionist/dietician? Is that something you have to pay for out of pocket since the refferal is only for the surgery or is all of that combined? O have so many questions its not even funny and it seems like I have been researching forever lol.. Thanx to those who read and respond. Your advise is very much appreciated..

I only saw the psychologist preop, but the nutritionist is part of the preop, several meetings, then included in the year post op.

I saw the psych once and the dietician once before surgery. I had to pay for the psych out of my own pocket and there was a fee for the dietician as well. Neither of these were covered by my insurance.

My psychologist appt $150 and the nutritionist was covered under Ins. I didn't even have a copay for it either. I am not banded yet and I'm waiting for Ins approval.

Tammy, its very important to keep good connections with your ins. company.

Everyone's insurance requires different things.

Leatha's insurance required her to have both - a phsyc. evaluation AND a dietitian consultation. MY insurance required one OR the other.

And only one visit was good enough!

(my consultation fee was about $35)

Thanx for the info.. I will call my insurance again tomorrow and continue to til surgery. I was told i only needed the referral to get approved. I will ask Charlie what all his wife needed to do since they have tricare prime and she also went to Dr. Smith..

Tammy, its very important to keep good connections with your ins. company.

Everyone's insurance requires different things.

Leatha's insurance required her to have both - a phsyc. evaluation AND a dietitian consultation. MY insurance required one OR the other.

And only one visit was good enough!

(my consultation fee was about $35)

Actually, my insurance never really required anything. It was the Drs office who seemed to be in cahoots with all those other folks. I did all that BEFORE my request for insurance approval was even submitted.

Hi Tammy...

It can be a slow process... especially when you are the waiting side. Just hang in there and jump through all of the hoops your surgeon may require. It was also my surgeon that required all of the hoop jumping... not my insurance... it was very frustrating. However... here I am... banded! I feel very lucky that my insurance did approve and that I didn't have to seek other avenues... it was worth the wait!

Darcy

I only had to see the nutritionist once and the psychologist once. Because of my high blood pressure and heart murmur, I had to see other docs also.

My insurance doesn't require referrals,so I actually made some of my appointments in advance to save time.

I called the insurance on a pretty regular basis for two weeks after everything was sent to them. First they told me they didn't have the papers from my surgeon, then they were faxed again.

My insurance is usually pretty good about approving surgery, but I still had to keep on top of them.

I didn't have to see a psych. and my only experience with a nutritionist was when some woman walked into my hosp. room right after surgery and handed a sheet of paper listing a vague and confusing diet to my husband. I, of course, was on a morphine drip at the time.... I did notice that her services were part of the charge on the hosp. bill, though!