Need help in where to start the process!!

[peki31 37]

I'm new here and kind of confused on what to do. I will be calling my physician tomorrow for a physical.

Some background: I am 34, 246, 5'5" and have tried every diet imaginable since I was 10. I was never thin. I've never had health problems related to my weight. Just recently though both of my knees and back have been in pain, so I think it's because of the extra weight.

I have Care First Blue Choice HMO so I would want them to cover the lap band (and would love to do it ASAP).

What do I need to do? I don't have receipts for programs I've done. I have books (Atkins, South Beach, some other stuff). I never saved receipts for diet pills I tried either. I am so confused...lol. Also I just had a baby last March. I think being pregnant has been my best diet. I lost over 20 pounds with each of my girls (of course gained it all back after delivery).

I would love some advice on how to speed up the process and get the ball rolling. Thanks!!!

Lana

[RestlessMonkey 7]

I started with my insurance company. If you want them to pay, you need an in-network surgeon and so on (if they cover it). It's the logical place to start! If they cover, use their requirements as your check list and get going! :cursing:

[SeattleSweetie 5]

Agreed, get in touch with your insurance company first - either through their website or customer service number, and ask for the names of any in-network bariatric surgeons or centers they work with.

Next, call whoever they refer you to - every bariatric doctor that I have heard of has an "introductory seminar" type event, if you will, that they require all new or prospective patients to attend. It's basically like a sales meeting where they tell you the benefits, the requirements, etc etc. While you're there, you'll get a packet of papers giving you next steps and exactly what to do to get started.

Also, I recommend you attend sessions like these with at least a couple of different doctors. You'll get somewhat different info from each one (such as their pre-op requirements, diet, etc), and you'll get a feel for who you really like or which doctor seems the most responsive, friendly, personable, or whatever traits matter most to you.

I went to three different seminars before I found a doctor that I really liked. He seemed much more thorough and strict about his pre-op diet and his medical and office assistants that were at the seminar were all very friendly and caring.

It would seem to some that they would want to go with a doctor who would go easy and let them get the surgery no matter what, but I wanted a doctor who was more strict and concerned with proper pre-op and post-op diet and whatnot because I felt he was more concerned overall with the general care of the patient, rather than having a lax, 'anything goes' type of attitude just to get patients in the door. The doctor I ended up choosing also had the lowest rate of complications, slips, and other problems, probably because he was so determined to help his patients take care of themselves properly.

Overall, it was a great experience, and there really is a HUGE difference between different doctors, so attend a couple of different seminars and go with your gut instinct. I know it will probably take an extra week or two to schedule multiple appointments and whatnot, but take it from someone who knows, picking someone you're really comfortable with is more important than getting into surgery a week earlier. You will be relying on this doctor and his or her staff for so much, you want someone you feel good about.

Once you've picked the one you like, contact their office or read through the instruction packet they gave you at the seminar. They will be quick to help facilitate and oversee everything you need to do, such as pre-op testing, evaluations, organize medical histories, etc. More than likely, they'll have certain doctors that they use all the time for various tests, so they'll know who to send you to for everything. When I started the program, I was actually given a checklist of each test and evaluation I needed to have done, the name and contact number for the doctor to do it, and the timeline of which things I needed to do first in order to submit for insurance approval, and then the smalled things I could have done later down the road.

Just talk to the doctor you choose, they'll get you going on the right path.

Edited December 4, 2008 by SeattleSweetie

[Lady Lap Band 71]

Go to Lapband.com and find a seminar near you, they are mandatory and are really the first step in starting the whole process. They are great, and will tell you everything you want/need to know.

The team at your hospital will tell you everything you need to do after that. They are usually great with walking you through everything! Good Luck!

[peki31 37]

Thanks everyone for your advice. I actually called my insurance company yesterday and was on hold on and off for almost 2 hours and they never called back. I will try again tomorrow. Do HMO's typically cover weight loss surgeries?

[RestlessMonkey 7]

Insurance is VERY different...even the same "insurance" can cover different things depending on the purchaser (usuallly an employer) and what coverage is selected. That's why it's best to start there, to see 1. if it's covered 2. what prerequisites they require (if any...and there are almost ALWAYS conditions to fulfill, some more tedious than others) and 3. if it's covered, which surgeons can you use?

If your insurance company/employer has a website you can check there. Just remember coverage can be modified by an employer (for example they can exclude bariatric surgery if they want to, since it is elective)

Good luck. It is tedious but considering surgery costs anywhere from 10K up to 20K, just think of it as "earning yourself" all that money by taking the time to find out if it's covered and so on!

[DrHekier 0]

Every insurance company is different. Your Lap Band surgeon's office should be able to help you. They might know right off the bat what your insurance company requires specifically. Here in Texas, many require a prior weight loss program. For some that can include programs such as Weight Watchers or Jenny Craig, but others are more strict and want physician documented weight loss plans. If your local Lap Band surgeon's office isn't sure call the insurance company again and use our template found on our site Texas | Arkansas Lap Band Insurance information.

Good luck

[peki31 37]

Well I just got off the phone with the insurance company and they told me that the group administrator excluded bariatric surgery. Now I'm so sad. There's no way I can afford $20k to pay for it.

[Blue Bug 0]

I'm so sorry. I know how this feels, as it happened to me a year ago....it was a line item exclusion on my husband's employer's insurance. Since then my husband switched employers and has Blue Cross, so it's covered now, but I'm waiting for approval. I definitely feel for you!!!!! There's no WAY I could do it without insurance. I'm still waiting for approval and hoping I will get it....then hoping I can afford the out-of-pocket expense even after the insurance!

Sorry :eek: