Futr littl Debi

Hi - About the Centers of Excellence requirement...that is a designation that the doctor / hospital program gets from an outside entity. It isn't an extra class provided by the insurance company. My insurance company has that requirement too.

Hi everybody. I too am from Southern California. I am a lawyer working in the compliance department of a major health insurance company. I am 47 years old and am looking forward to being healthier. I was scheduled for surgery on June 2nd after 4 months on the waiting list. They canceled surgery at the last minute due to a bad pre op test result on my thyroid. We should be able to get it under control soon and get me rescheduled. But boy - I was really looking forward to getting on to the next phase of my life.

I too was scheduled for June 2nd, but at the last minute, the doctors decided that my thyroid levels were too high. I now have to see an endocrinologist and get signed off there. The surgeon swears that I won't have to wait another 2-3 months to get back on his schedule. Jeez...it took 4 months to get on his schedule the first time. I then found out that I can't get in to see the specialist until June 19th, so I figured what the heck. I went to Vegas. I am soooo bummed.

I'm on the 2nd too! I can't wait. Let me know how everything goes.

I have told a couple of people at work, my kids and my sister. I wasn't planning to discuss it with my mother because she can't keep anything private. Unfortunately, she overheard me ordering Optifast over the phone for my last week. So I told her about it. Of course, she immediately told all of her friends. It's not that I am shy about the surgery - I just don't want to be the topic of their conversation. And now they are saying they will be watching me to see how I do so they can pass the word. I'm not wild about being watched.

Hi everybody... I know it's a ways off, but my date is June 2nd. Anybody else for June yet?

Martucci - be careful about choosing the doctor. Because you have a Medicare Advantage plan, you have to use one of the doctor's that is contracted with your plan. Also, if the Medicare Advantage plan is an HMO, you will need to get a referral from your primary care physician to see the bariatric surgeon. It is true that the Medicare Advantage plan will follow the Medicare guidelines, but that just means that they will cover everything that Original Medicare covers. Call the customer service phone number on your Medicare Advantage card to find out what you need to do to get the surgery covered under your plan. Good Luck!

I'll be in Fountain Valley, CA. Good luck in Colorado!

My doctor was not happy when I told her I wanted WLS. She had had only 2 patients who had WLS and neither of them did very well. But when I told her I wanted lapband and not RNY, she was MUCH happier. She now asks questions and is making sure I get any appointments set up that might cause obstacles with the approval process. I love my doctor.

Hi Cakegal...I'm going with Dr. Leport's group as well and went to the support group in January. You are right, there is actually only 1 regular that has the band. But there was somebody there that told me about this site. It was probably you! If so, thanks. It's nice to know that there are others in my same situation. My surgery was just approved a couple of weeks ago, and they called to schedule last week. They didn't have any openings until June 2nd! So I'm waiting again, but at least there's a date in my future.

You are so lucky! Congratulations! I heard from the doctor yesterday too. He is all booked up until June 2nd! I couldn't believe it...insurance approval in 10 days, but can't schedule surgery until June. I guess everything couldn't go smoothly.

You should check your policy. Usually, if WLS is covered, it is covered for over 40 BMI or 35-40 BMI with comorbidities. I would appeal the decision. They may be making the decision based on the wrong criteria. I would just point out that your BMI is over 40.

Congratulations on getting your date!! I received my approval yesterday, now I'm just waiting for the scheduler. We seem to always be waiting for something... Anyway, I would start writing down your questions and talk to your doctor. They really do have answers for you.

SecureHorizons is the Medicare product from PacifiCare. If you qualified for the surgery itself, PacifiCare used to require a 6 month telephone counseling, plus a psych eval and nutritionist. They recently dropped the telephone counseling requirement. Because PacifiCare and SecureHorizons are offered by the same company, they probably have the same requirements, but no guarantees. My doctor's office knew exactly what my insurance requirements were when I went in for the seminar. I would think your best bet would be to check with them.

Wheetsin, you are correct. Group insurance carriers are not permitted to have different provisions for individuals under a contract. Companies can buy different insurance plans for different categories of employees (officers vs. regular workers), but it has to be clear what the categories are and the purchased plan has to apply to everyone in the category. If the insurance is an individual plan, then the individual could buy a rider for their coverage that wouldn't apply to anyone else that the insurance carrier covers. But that's one of the main differences between Group and Individual insurance.

As long as you keep your Employer based coverage, you won't have any issues with portability. The problem with getting an individual plan is that the laws for individual health insurance allow the insurance company to set their rates according to your health risks. For people in our situation, that means that the rates are going to be high. Also, individual insurance companies are allowed to impose exclusions for pre-existing conditions. If they do this, you would be paying a large premium for the individual insurance along with the premiums you are paying for your 2 employer based plans. And after all that, the individual plan could probably deny coverage for weight loss surgery due to the pre-existing condition. Yuck...