samnic

Dr waked

Hopefully Dr Iriqua will be revising my band to sleeve.. any suggestions?

Help!! I am wondering if anyone has any experience with Highmark after having a revision. I am looking to have a band to sleeve revision but I am concerned that it may possibly not be covered due to my current BMI which is 35. According to my plan coverage it states it will be covered at 35 with at least 1 co morbidity if there was failure to lose weight or complications which I fit.

My concern is the co morbidities. I have had sleep apnea when I was diagnosed prior to banding 5 years ago but unsure if I do currently .. although my husband and kids say I am snoring really loud now again.. but I haven’t had and new sleep studies. I really need to get this surgery done and I don’t want to disqualify myself for insurance payment. I really don’t want to gain weight ..any suggestions or input on what I should do!!!!!

HELPPPPPP!!!!!!!

Thanks I was just wondering because some people have told me that the doctor submitted the info around 5 months and they were approved . thanks for the quick response time

I am so tired of the waiting game, technically I guess I really havent waited that long yet . My first appointment was march 30 th and my supervised diet began then. I was just curious to find out for those that had to have a 6 month supervised diet required by insurance ,did you literally wait 6 months before the doctor even applied for authorization or was it less time ? and exactly how long was your process from start to finish? I am becoming restless. I guess Ive waited this long. Whats another 3 months????? I think Im going to drive myself crazy. Please bandsters shed some light on this for me

Hi There,

I am in the same exact situation. I too have a BMI of exactly 40 and have to participate with a 6 month supervised diet. I started in march. I basically can not lose any weight, although I was recently diagnosed with High BP so the physician said I could go down to a BMI of 35 but I choose not to do that. It sounds crazy but I dont want anything to jepordize me qualifying for this surgery. I too have lost 40 lbs about 4 years ago and havve once again gained it back. I just want this process to be over already. I am ready to begin a new life, that is pain free-(without knee pain). I dont think the insurance company will deny you if you dont lose any weight. Let me know if you find any more information about this. Good luck!

I have CIGNA as my insurance carrier, so I have the 6 month requirement to go to weight loss classes under a physician's supervision. While this is a bummer because I really want to get going with the lap band surgery and not wait 6 months, I have an additional concern. I am exactly at a BMI of 40. If I lose so much as 10lbs, I won't qualify for the lap band. I am sure I could go to a 6 month supervised clinic and lose 15lbs - and then regain it as soon as I stopped. Or keep it off and continue to struggle being 85lbs overweight instead of 100. Sure, I would love to go to a 6 month thing and lose 50#s and not have to have the lap band, but I've lost 50lbs before only to regain it. It wasn't physician supervised, though so I don't think it counts for CIGNA.

I also am unsure of what I have to do to have it count as 6 months supervised. The university hospital has a 6 month program (in the same division as the bariatric surgery program), but it costs $1,000. And of course, CIGNA doesn't cover it. I feel so stuck. I really thought the Lap Band was going to be an option for me, but now I feel like more roadblocks are up in my way. I am not trying to be a size 4, just to be "normal." I want to wear clothes from normal stores, to be able to spend the day at the zoo or shopping mall without having my feet and knees hurt for days afterwards, to sit on the bleachers and watch my daughters' games and not have my back kill me because I don't really fit on it, and on and on.

Does anyone have any advice?

Thanks for the great feedback. This is a great community here on lapband .com. I wish I had known about this sooner!!!!

Congratulations on getting the ball rolling. My surgeon's office has a coordinator that keeps up with everything I need to do. They gave me a checklist of all the tests etc. I need and we are checking them off as I go. Psych. eval is next week, sleep study is to be scheduled... etc. They are double-checking my insurance requirements for the supervised diet but in the meantime I saw the nutritionist for the 1st appt. so if I do have to do 6 months I am not wasting my time. Once I have all the tests done they will submit it then and then we will schedule a date. They told me the clearance takes from between a couple of days to a few weeks depending on how busy the insurance people are.

Good luck!

ThAnks a lot. Thankfully I spoke to a wonderful rep at my insurance co today and she gave some great input. At least I know for sure that my plan Includes bariatric sx. I just have to go to certain doctors in the network. One step closer.

Thanks I have called my insurance and they said it is covered but they didn't say anything about a supervised weight loss diet plan prior to sx. So I don't know what I need to do.

Hey Bandsters,

Can anyone tell me what your process was following your intial consultation for the lap band? How soon did you hear anything from the insurance? I am getting so many different stories from my doctors office and I am confused. When I talked to one person they told me I need to perform all my medical clearances before they submit anything to the insurance company, which in one way makes no sense, then they told me go ahead and start a 6 mo supervised diet because usually coventry insurance requires this, but no one has called my insurance company directly to find out anything so how are they even sure that my insurance will even cover this procedure before I do all of this???? Please help!!!!!!!!!!!!!!!

I would like to continue where I am but trust me I will definitely think about it. I am still trying to figure this process out. How long til the doctor submitted your claim for surgery? How long was it when u heard anything back from coventry? The physicians office told me that i need to go to the clearance appts before they can submit anything . Is that true? Sounds backwards. How r things going with you? So u said u have to wait now until it is a center of excellence? What's up with that?

I am excited for you and I would love to be your buddy. I still havent heard anything yet. The way it was explained to me by a Coventry rep is that bariatric surgery is covered and that depends on your employer group whether they include it in your coverage. The bariatric coordinator had explained to me that I have a special situation, in which my insurance covers but the facility that I will have the surgery at has a contract with coventry at the delaware surgery center in dover but they may not include bariatric sx in that contract so she has to contact delaware sx center in dover and speak with the person who handles the insurance contracts and find out whether coventry covers procedures done there. Im biting my nails still. I need to do something about this weight. This is the largest I have ever been and its killing me. I am a RN so Im pretty much always on my feet, my feet and knee are killing me. Im just waiting (cant really say patiently) until I hear something back. I am glad you have gotten through this process. I cant wait to hear how everything goes for you.

Hi there! I have Coventry and have been approved for my surgery. I will tell you though, I found a loop hole luckily with mine. I live in Delaware, but work in Maryland. Delaware does not cover it unless your policy is different than mine. However, because I work in Maryland and there was a law past in July 09 that says all Maryland Ins companies MUST cover the surgery. That was my loop hole and I thank God when I found out. I've had to go through 6 months worth of Nutritional classes (the first visit was one on one with Nutritionist and the last one will count with the Surgeon) so basically you only go 4 months. I also have to get clearance from the Physc, Heart and Lung doctors. I only have the Lung doctor to go to on March 31st. I'm having my surgery done in Milford by Dr. Brebbia. Best of luck to you!

Thanks for the response. I am so anxious about this whole thing. I have found out that thru my plan from coventry my employer does cover bariatric surgery. I m just afraid that just my luck they will find some clause that keeps my surgery from getting approved. Are there any questions that I should possibly ask of the insurance co. Where did you find out the info about the law passed in 2009? I actually work in milford hospital. I didn't know Dr brebbia did bariatric surgery. How long did it take for them to approve your procedure and how did you find out that you had to complete a nutrition program. I wish you the best of luck. I would love to get an update on how you are doing post surgery. Thanks again

Hi there! I have Coventry and have been approved for my surgery. I will tell you though, I found a loop hole luckily with mine. I live in Delaware, but work in Maryland. Delaware does not cover it unless your policy is different than mine. However, because I work in Maryland and there was a law past in July 09 that says all Maryland Ins companies MUST cover the surgery. That was my loop hole and I thank God when I found out. I've had to go through 6 months worth of Nutritional classes (the first visit was one on one with Nutritionist and the last one will count with the Surgeon) so basically you only go 4 months. I also have to get clearance from the Physc, Heart and Lung doctors. I only have the Lung doctor to go to on March 31st. I'm having my surgery done in Milford by Dr. Brebbia. Best of luck to you!

has anyone dealt with coventry POS of md or de , trying to start the lap band process, went for consultation and have a bmi of 40 with co morbidity of joint problems, has anyone had any experience with them ? If so did you get approval