alamergrl

My countdown ticker disappeared so I guess it's about time to go!!!! Yippee!!!!

my surgeon in kansas city charges 11999 for a sleeve or lapband cash pay.........the practice is a center of excellence and performed the most in kc last year

Congratulations! I know you are relieved!

I would like to join this group. I've been an RN for over 27 yrs. I work for a major insurance company as a supervisor of utilization managment. My surgery is scheduled for August 12. I'm so excited to finally see the light at the end of the tunnel. My job is very sedentary and I struggle with remembering to drink while I'm working.....hopefully will get in the routine. Good luck to everybody just starting their journey.

Our stats are about the same and we will be sleeved the same day! I'm Aug 12th as well! From what I've seen and heard, as long as you follow your diet from the doc and NUT, you should lose and maintain. Only people I've heard of gaining back are those that stretch out their new pouch and go back to their old eating habits. Our stats are about the same and we'll be sleeved the same day! Looks like we'll be in this together!

You could also call the surgeon's office and see if he would be willing to do a peer to peer review with the insurance company. That might be quicker than starting a full blown appeal. If the peer to peer doesn't work you can still appeal.

You need to check your summary of benefits but the majority of Coventry plans do not cover bariatric procedures. However, there are some states that require bariatric coverage. You can also call customer service and they can let you know if it's a covered service.

i'm also an insurance vet and that is how it works......post op if you have complications that require a longer stay the hospital can request approval from the insurance company for inpatient status. Your care is determined by the physician but the payment is generally determined by the insurance company. I'm scheduled for a sleeve on August 12 and it was requested and approved outpatient. I'm going to hit my max out of pocket regardless so it's fine...... usually outpatient surgeries are paid in a lump sum and inpatient is paid at a daily rate (all depends on contracts) so outpatient is usually the most cost effective for all involved. You notice I use the word usually a lot because there are always variations to everything. Good luck and congratulations on your approval.

I'm scheduled for August 12th! So ready to get on the loser's bench!!!

I also live in Wichita but I'm going to Kansas City for my surgery. I won't elaborate with why I say this but I wouldn't let any of the surgeons in that group touch me. Frankly, I'm not surprised this happened. I have seen his patients have a lot of complications post op. It's been worth the 8-10 trips to KC to go where I feel safe. Wishing you the best with whatever your decision is.

I finally have a date. I was hoping for July but my surgeon is scheduling 5 wks out so August 12th is now my date!! So ready to get this done!!

It's different for every plan. Every pollicy is different. I have a high deductible plan thru Aetna. max out of pocket $3600+250 office fee. and i will meet that with sleep study, cpap, cardiology eval w/ stress test, egd, and appts.

I'm hoping for July 24 too! Last appointment with dietician is June 30, then if approval goes smooth I'll be a July sleever too!

My understanding is that the acid in tea and coffee can cause ulcers and complicate the healing. May not be accurate but makes sense. My surgeon says no ceffeine for 8 wks post op and then in small amounts. I did find out today that decaf is ok! Will make it a little easier since I've been drinking tea instead of carbonation.

I'm going for my pre op class on Thursday so I can't help with that. I think it's the PA Tim and the dietician Laura going through specific instructions. The psych eval was very simple. He just talks a little about motiviation and then you take several written (easy) tests. I meet with him again on Thursday afternoon to find out if I passed. :-) I've been told that he has never failed anybody in the psych eval.

I am hoping for a July surgery date. I'm about 5'0 and 218#. I'll be 50 years old in October. I'm going for my EGD next week, preop class on 5/29, last nutrition visit 6/30 and then it will all be submitted to insurance. If everything goes smoothly I'll be sleeved about the same time as you :-)

Here is what it says directly from Aetna's policy............ Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record at each visit. This physician-supervised nutrition and exercise program must meet all of the following criteria: or Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Records must document compliance with the program; the member must not have a net gain in weight during the program. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records; and Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists, with a substantial face-to-face component (must not be entirely remote); and Nutrition and exercise program(s) must be for a cumulative total of 6 months (180 days) or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least 3 consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of 6 months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.) Multi-disciplinary surgical preparatory regimen: Proximate to the time of surgery (within 6 months prior to surgery), member must participate in organized multi-disciplinary surgical preparatory regimen of at least 3 months (90 days) duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions: Behavior modification program supervised by qualified professional; and Consultation with a dietician or nutritionist; and Documentation in the medical record of the member's participation in the multi-disciplinary surgical preparatory regimen at each visit. Records must document compliance with the program; the member must not have a net gain in weight during the program. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multi-disciplinary surgical preparatory regimen.); and Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and Program must have a substantial face-to-face component (must not be entirely delivered remotely); and Reduced-calorie diet program supervised by dietician or nutritionist. Good luck!!!