HI

I have a surgery date of 12/22 and my last preop clearance is this Wednesday. I am so scared I am going to be denied my bmi is 40 with no co morbidities.

My primary doctor called me this week and said she doesn't know why I would need her clearance since I have already been cleared by cardiologisst and pulminolist. She said she wouldn't even see me unless she gets something in writing from surgeon. Then she says in her experience they don't even meet with you unless you have already been approved.

Now I am so confused. I thought approval came after all preop tests. She seems to think otherwise.

I had all my tests and sleepstudies paid for by insurance but nutritionist was not.

Anyone know what is going on?

I am getting banded in Delaware

HI

I have a surgery date of 12/22 and my last preop clearance is this Wednesday. I am so scared I am going to be denied my bmi is 40 with no co morbidities.

My primary doctor called me this week and said she doesn't know why I would need her clearance since I have already been cleared by cardiologisst and pulminolist. She said she wouldn't even see me unless she gets something in writing from surgeon. Then she says in her experience they don't even meet with you unless you have already been approved.

Now I am so confused. I thought approval came after all preop tests. She seems to think otherwise.

I had all my tests and sleepstudies paid for by insurance but nutritionist was not.

Anyone know what is going on?

I am getting banded in Delaware

Usually your PCP needs to send your surgeon a letter of support and diet history. All insurance companies are different. You should also receive a letter in the mail stating that your surgery was approved. I would recommend calling the insurance coordinator at your surgeons office and see if it was cleared or call your insurance company directly. As I said all insurance companies are different but they usually want a letter from your PCP as part of the clearance. Also call your surgeons office and let them know that your PCP is refusing to see you unless they call he/she first.

My paperwork was submitted AFTER I met with the surgeon, nut. and psych evaluator. Although I had documented information from my pcp, it wasn't requied - or needed. My surgeon's office took care of everything. They have a person on staff (each dr' office has one) that coordinates the information submitted to the insurance company. However in my case, I was appproved way back on August 6, but never heard anything from my insurance carrier (Anthem) as far as a definitive answer. My doctors office never received notification either. My husband had to call Anthem directly and was told my surgery was approved (apparently by the wrong department.) I FINALLY got a copy of the letter a couple weeks ago and forwarded it to my doctors office.

Interesting note, when my husband called the insurance company, the lady he spoke to kept mumbling that they don't just accept the first round from the doctor, that I'd have to do this and that to get approved. When she read the letter allowed to my husband, she changed her tune. Her comment was "Wow, they must of read the script of exactly what we needed and followed it when they submitted her data." ... Exactly what I would expect from a doctors office.

I know when I went to my first orientation, they had a insurance specialist that worked for the surgeons get all my insurance info to see if they in fact even covered my planned lap band surgery. She called me two days later saying they approved this surgery, but it was NOT the final approval we all wait so breathlessly for. That most often comes after you complete what your surgeons Nurse/ Bariatric Surgey Coordinater or Office Manager tells you you are to do. My requirements were releases from a Psychologist,Pulmonologist, and Cardiologist, and Nutionalist (probably all spelled wrong).

All insurance companys are different, just as are how the Doctors requirements are. I have read here where people have received their approval and still had a few dr. visits left to complete.

Don't sweat this one out, it sounds like your surgeon and his staff have it all under control.:Yawn:

~Cheryl

thanks,

I did go to what seems like a million appointments already and have been cleared by all of them for surgery. On Wednesday I meet with anesthesologist (sp?) and surgeon, have final blood work and a chest xray.

I know when I talked to their insurance coordinator she said they submit after my final appt on Wednesday, but after talking to my primary she said in her experience they don't even let you walk in the door unless you have been approved.

Just confused and worried about what is going to happen. I feel like this is my last hope to get my weight under control, I don't know what I will do if this doesn't go through.

I cannot imagine them having you meet the anthe. and having final blood if you were NOT approved.

Good luck and let us know!

Hi:

You should call your insurance company and ask them for a confirmation number for the surgery that you are approved for. Write it down and save it. I remember I got a letter in the mail, but it was weeks after I heard from the person who coordinates the surgeries at my LapBand doctors office.

Best wishes to you on your band journey. I love my band and my new flat tummy!

Sue

I didn't wait on someone to notify me. I called my insurance company daily and asked for the status of my paperwork that was submitted for lapband approval. My insurance company required a letter of medical necessity from my PCP before they would approve - something I was not advised of beforehand. I called Cigna daily and was finally advised on 11/22 that I was approved and provided an authorization #. To this date I have received nothing from Dr or surgery center advising they received notice of my approval. If I hadn't done this all myself, I would still be waiting. Call - take charge and ask questions - it's your right.

Ask your surgeon's office if you have been approved. Mine called me to schedule my Pre-op visit and tell me I was approved WEEKS before my insurance company sent me the approval letter

Call you insurance company and get the confirmatin number. I got a letter from insurance stating that I do qualify, and they will pay, but no confirmation number. When time came they refused to pay:cursing:. Had to post pone my surgery and jump through more hoops and get a appeal before they agreed to pay for the surgery. Once I had the confirmation number I had 30 days to get the surgery done or I had to go through everything again. I was able to get the surgery done and insurance payed for it:thumbup:. Lots of prayers went up for me from my family and friends. I will say one for you. Good luck.