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minpinmom

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I constantly read all the blogs about weight loss - they are so inspiring. I never really imagined I would have the opportunity to become a wls blogger. Life changes fast. I have been trying to get Lap Band surgery for 3 years. My insurance company, Tricare Prime, excluded the procedure. Of course, I didn't find this out until I had done all of the leg work . . . let me take you back a few years.

The year was 2006, I had been researching Lap Band and knew I wanted it. I checked with my insurance and the manual said wls is covered if you are . . . then it listed the types of surgery. One of the ones it listed was vertical banded gastoplasty. I just assumed that was lapband. I went to my PCM, he said that he thought it was a great idea, gave me a referral to the Dr. (Dr. Spiegel), who was in Network. I went to the seminar, met with Spiegel, he said that I was a great candidate. They said I need to have a psyh eval and to meet with a nutritionist. I waited forever for a psych visit. Finally got in. I tried to find a Nutritionist that was in network and couldn't find any - so I called my insurance company, I explained that I was trying to get a consult for lapband. They quickly informed me that lapband isn't covered. I was devastated. I couldn't believe it. Sure enough, I hadn't done my research well enough. It was an excluded procedure. (They quickly approved me for Gastric Bypass) So, I decided I would either change jobs to get medical coverage, or try to be self-pay. After talking with all sorts of people on lapbandtalk, I realized that most of them were under the impression that our insurance would change come January 2007. I waited with baited breath. January, February, March, . . . nothing. I made the decision that I was going to wait till the first of the new year, then go self-pay. Come December 10, 2007, the word came down fast - it was going to be covered. I had never been happier.

 

I had to make another appointment with my PCM, to get another referral to see Dr. Spiegel. I met with Dr. Spiegel on December 20, 2007. I brought all of my paperwork with me, gave it to the nurse to put in my file with instructions how to progress with my Insurance. I should have been suspicious when she didn't write any of it down. I waited until January 3 to call back (Christmas and New Years). They had called, asked if it was covered, got a NO and sent it back. I explained that the change wasn't in the system yet. Explained again how to deal with it. Finally, they got it.

 

My paperwork was submitted to the Insurance January 22, 2008 :eek:

I am waiting ever so patiently for the approval. Please, please come fast.

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I constantly read all the blogs about weight loss - they are so inspiring. I never really imagined I would have the opportunity to become a wls blogger. Life changes fast. I have been trying to get Lap Band surgery for 3 years. My insurance company, Tricare Prime, excluded the procedure. Of course, I didn't find this out until I had done all of the leg work . . . let me take you back a few years.

The year was 2006, I had been researching Lap Band and knew I wanted it. I checked with my insurance and the manual said wls is covered if you are . . . then it listed the types of surgery. One of the ones it listed was vertical banded gastoplasty. I just assumed that was lapband. I went to my PCM, he said that he thought it was a great idea, gave me a referral to the Dr. (Dr. Spiegel), who was in Network. I went to the seminar, met with Spiegel, he said that I was a great candidate. They said I need to have a psyh eval and to meet with a nutritionist. I waited forever for a psych visit. Finally got in. I tried to find a Nutritionist that was in network and couldn't find any - so I called my insurance company, I explained that I was trying to get a consult for lapband. They quickly informed me that lapband isn't covered. I was devastated. I couldn't believe it. Sure enough, I hadn't done my research well enough. It was an excluded procedure. (They quickly approved me for Gastric Bypass) So, I decided I would either change jobs to get medical coverage, or try to be self-pay. After talking with all sorts of people on lapbandtalk, I realized that most of them were under the impression that our insurance would change come January 2007. I waited with baited breath. January, February, March, . . . nothing. I made the decision that I was going to wait till the first of the new year, then go self-pay. Come December 10, 2007, the word came down fast - it was going to be covered. I had never been happier.

I had to make another appointment with my PCM, to get another referral to see Dr. Spiegel. I met with Dr. Spiegel on December 20, 2007. I brought all of my paperwork with me, gave it to the nurse to put in my file with instructions how to progress with my Insurance. I should have been suspicious when she didn't write any of it down. I waited until January 3 to call back (Christmas and New Years). They had called, asked if it was covered, got a NO and sent it back. I explained that the change wasn't in the system yet. Explained again how to deal with it. Finally, they got it.

My paperwork was submitted to the Insurance January 22, 2008 :)

I am waiting ever so patiently for the approval. Please, please come fast.

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