I just spoke to my insurance. They said it would be covered 100% if I used Dr. Nusbaum, here in NJ, and it is deemed medically necessary.

Anybody here seen Dr. Nusbaum?

Also, who decides if it is medically necessary? :biggrin:

Yes, Dr. Nusbaum is my surgeon! He is a doll - I am being banded on Tuesday, June 24th and am very excited (and a little nervous too!). At my consultation he was patient, kind, explained everything fully, answered my questions and never made me feel embarrassed about my weight. His staff is equally as wonderful - my bariatric coordinator is Wanda and she is extremely good at what she does and just a great person to just talk to. I am lucky to have great insurance so my consult date and surgery date are only 1 month apart - in fact I made my surgery date at my consult - Dr. Nusbaum requires a psych consult, venous dopler of your legs for blood clots, blood work, PATs at St. Barnabas Hospital (also very good - the day I went for the PATs I was in and out in less than 30 minutes!), and chest xray. No pre-op diet other than 1 day prior to surgery - I must have clear liquids only. I did have a vena cava filter implanted (to avoid blood clots traveling from your legs and cause a pulmonary embolism) - he suggested this procedure because of my weight and family history - so it was day surgery - not bad at all - and everyone was great - wanted to know when my big day is scheduled.

The LB is something I have researched and considered for several years. I am not a chicken - but I did have concerns - Dr. Nusbaum addressed those concerns and gave me the assurance that I needed to feel comfortable with going ahead with the LB procedure. He was recommended to me by a colleague and another friend who also found him to be highly capable and compassionate. As of this date, I can only say good things about him and his staff. Best of luck as you make your decision - I will let you know how I make out - only 4 more days! - Music Mom

My insurance said they'll pay 100%...just have to prove that it is medically necessary. That's the party that I'm worried about. How hard is that going to be? Guess I'll have to wait until I talk to the doctor. My consultation with him is on July 14th.

Check your BMI - I think Oxford said 39 or 40 is what they look for. Also, do you have high BP or some other medical problem that would benefit from loosing weight? I have RA and high BP - my doctor's said they would write letters but none were needed.

My biggest problem is my back and leg pain, but my cholesterol keeps creeping up and my blood sugar is high. There is a strong family history for diabetes and cholesterol problems, so I know they will only get worse. My PCP told me that if I didn't take care of the blood sugar, I'm going to have diabetes. And, then there is the depression, which is bad. I think I'll talk to my psychiatrist and chiropractor before my consultation to see if I can get letters beforehand.

Best wishes on Tuesday!! I can't wait to hear how you do.

Medical necessity is fairly easy to get, actually. Esp. if you have a track record of trying to lose the weight or any other medical problems, sleep apnea, etc. The staff will generally work with you to get approval, as long as they feel you do need it.

Wonderful, Wonderful choice. I think your primary care phys. as well as the surgeon can deem the surgery medically necessary. Good Luck. You'll just love Nusbaum and his staff. :grouphug: