Bozzj

Hey, i have an idea. Typically they like numbers. So, why not list your monthly expenses that they cover (doctor visits, meds, etc) and then show them how it would be reduced in the long run $$ wise.

I know, it sucks. Make sure you're talking to the right person though...someone in benefits...and if they do not call you back within 48hours email the HR Director. You want to ask them if they have an appeal process for WLS. They might not answer you directly so ask them to refer you to the page in the insurance coverage booklet where it describes the process for WLS. HR should never take more than 2 days to get you an answer. Good luck!

crazy idea..ohio isn't TOO far from NJ. Why not come here and have the surgery and just get filled by you? Maybe you can work out a price for just the surgery in NJ (i'm going to Dr. Ewing) without the year of fills and pay the 300 bucks by you to get filled??? In an outpatient facility with a year of fills it's costing me 15k. So, it would probably be much less without that... just food for thought.

Hi, I understand your frustration. I work for a private company that is self-pay- meaning the company pays the claims, not my insurance. I'm in HR so i knew this and decided to go the self-pay route (scheduled for 4/17) to avoid the hassle. Maybe your company is self-pay also? They would never advertise that to the employee population, but being in HR I sat in on the meetings. It's frustrating, but many companies don't cover wls because it's $$$. Appeal it..it'll go to Sr. Mgmt and they will decide. They will not know who you are- just that X employee in X dept requests X for X reason. If they reject again, Appeal it again. Sometimes though, companies do not have an appeal process in place for things like that. Find out from your corp. HR team. At my company it would be covered, but they'd know who I was because..i'm the only fat one in hr!! I don't want them knowing my business... good luck!

I'm scheduled for April 17th. I'm self-pay in NJ and it'll cost me 15k. That's in an outpatient facility NOT the hospital. If i got it in the hospital it would cost me upwards of 32k.

Great thread...i'm young as well...28...newly married (a little over a year). On paper I look like i have a fantastic life: great job, hubby, family, a few great friends, but i'm very overweight (5'5, 292) and i'm "feeling" it. I'm looking forward to not thinking about where I can go out...right now i know the booth sizes of all the local restaurants, etc. I'd like to fly without pain in my thighs. SO I decided to get the band and put in the hard work afterwards. I'm not scheduled yet, but i'll report back when i am.

Hi, I went to my consult today and i'm in the process of setting a surgery date (my husband and i decided to self-pay). I was thinking of getting it April 1st, but just realized i'm traveling for work on 4/13 for a few days. Do you think i'll feel ok to do this or should i wait? I'll be taking a week off from work after the surgery, but i'm not sure if it's ok to travel. While away i'll be attending a conference and can go to my room whenver i want if i'm not feeling well, but again...is this a good idea?

Hi All, I have BCBS, but I may end up self-paying (not sure yet) for a bunch of reasons. My question is what is the difference in regards to the process/timeline if you're self-pay vs insurance? Long story short...i really don't want to wait a long time to get this and today I found out that my company-not insurance-makes the decision to pay or not. I don't want them to know my business...so i may opt to self-pay. Not decided. Would that speed up the process? Do self-payers have to go through the same steps? Thanks

thanks for sharing your experiences. I'll probably end up going the self-pay route. My hubby and I spoke yesterday and he is not in favor of my company knowing my business. Meaning, the company I work for pays the claims, not the insurance provider. This means if I go to the doctor- i pay whatever my share is and the company, not bcbs, pays the rest (this is new as of this year). SO, with this kind of surgery sr. mgmt would most likely be alerted that an employee (no name mentioned) from X department requests X. Then they approve it or not. I'm the only bigger person in my department. This is my understanding of how it works and i don't want people knowing my business. That being said, i still have to go to my consult on Monday and discuss payment options. They did say they have financing options (or we might go the ccard route and then just pay it off later this year). This, of course, is for the outpatient facility and not hackensack hospital (the hospital is about 30k). I want to make sure that the price the doc gave in the seminar, 15k (with first year of fills) covers everything and there's no hidden fees or whatever.

Hi All, need to vent...and i know in a few days i'll think more positively, but i went to my first seminar yesterday --and met tracey from here :-) --and everything was really good. THEN they say that Horizon BCBS requires you go to 6 months of supervised diet. I knew there was a chance of this..and i know it's a step in the right direction, but i really wanted it now! I know i'm being a baby, but i'm disappointed. I have my first consult in two weeks and i guess i'll ask them how i go about this 6 months thing..and if we start any of the testing prior to then. I was so sad last night that i was thinking of self-pay (which i know is stupid if my insurance will cover it...but i wasn't rational at that point) and to get it done in hackensack hospital it's 25k-32k!!! It's 15k in a smaller outpatient facility. Anyone go through the 6 month diet? Do you go to your lap doctor for that? I'm not sure if that's possible, but i'm afraid if i go to my regular doc and he doesn't write the right thing i'll get denied. ALso, do you start all that testing AFTER 6 months months or do they start some of it during the waiting period? I'm confused. The seminar was packed and I'll ask him all this as well in the consult, but i'd appreciate your experiences. I guess what is the most annoying is i diet all the time and i didn't doctument it with a doctor. AND if i could diet and not be starving all and and end up giving up...then i i wouldn't be getting the surgery in the first place. :cursing:

never thought i'd be on a board where i'd shout my weight :cheers2: but i'm 5'5 and 290. I don't have the band yet, but i do have my consult in a week. My goal weight...well i have a goal, but it's not in lbs. I want to fit comfy on an airplane again. When i hit that i'll feel so successful. After that...i just want to be healthy. I hear bypass is faster, but the band is safer so that's the route i'm going.

i'm in the learning/consult process...and i will not tell anyone except people i really trust (i.e husband, parents, brother, my fav aunt and grandparents). that's all on one side of my family..the other will judge me. my in laws aren't the nicest so i'll never tell them. reality is you'll have to diet and excercise to be successful so that's what i plan to say.

not to scare you, but when i went to my seminar this week they had stat's that said valley hospital had a high complication rate. is it possible to get it done in hackensack? Maybe i heard this wrong--ask Tracey on here she was at the seminar...but i think that wing is closing in valley hospital too sometime soon. that might leave you stranded down the road. again, just look into it..i could be wrong.

update: i called the lapteam and they said they provide the 6 month dietplan. I'm going on 2/19 and on 3/3 for the consult. Kind of backwards, i know, but i need to get this ball rolling. I'm just so confused on what the insurance wants..they won't tell mand and the lapteam said 6 months.

Hi All, Tracey and I met yesterday at the same seminar. Tracey--I called BCBS and they would not confirm/deny the 6 month wait. I wanted to scream! I did make an appt. with my primary for next week to start this 6month thing...but now i'm thinking I should call the lap team to see if they can do it. I mean they would know what to write- worth a shot i guess. I'll report back..and if not go to the primary. I'm very disappointed because i was talking to my parents giving them the scoop from the seminar and i said, "the doc will have to write a note at the end of the 6 months to say it didn't work and provide all of the details so i can get the surgery." My mom got furious saying i'm not taking this serious and should try to "Make it work." THIS is why i didn't want to tell people...they live in FL they'd never know anyway...and i was hoping she'd be more supportive like before. I'm blue.

good question. I'm so excited to go tonight (tracey and I are going to the same seminar) YAY.

me too! I'm from north nj...attending a seminar on weds (tomorrow). Good luck to you!

hi all, ok so i'm sitting here reading the board and i had a slight panic. i'm going to my first seminar on weds. and will then make the consult apt. etc afterwards...but i was sitting here thinking 'will they approve me (insurance) if i haven't had a physical in a couple of years?' Is this a weird freak out? I go to doctors often because of some other issues, but i haven't had a physical in forever. does that matter? also, someone was just telling me that if i haven't went to "paid" diet plan (such as jennry craig)in the last year i won't qualify (now she never had the surgery so who knows if that's true). Does that sound right though? I mean i'm a lifetime member of J.C and been to weight watchers a million times, but in the last year i've been attempting to diet alone. sorry for the long rant..

Really? Are you in NJ? Definetly report back...hopefully it goes well!!

I got the same info from Horizon BCBS (NJ). So, what i did was researched doctors in my area and signed up for a seminar this wednesday. The doctors at this practice accept BCBS so i figure that's a step in the right direction. I've made up my mind that i'm getting the band whether or not insurance covers it, but i'm going to do whatever they say if they'll cover it. I have a high enough bmi (almost 49). It's so weird...normally i'd hide my bmi..on this site it's ok to shout it out, hehe. I'll let you know how the seminar goes...

I got the same info from Horizon BCBS (NJ). So, what i did was researched doctors in my area and signed up for a seminar this wednesday. The doctors at this practice accept BCBS so i figure that's a step in the right direction. I've made up my mind that i'm getting the band whether or not insurance covers it, but i'm going to do whatever they say if they'll cover it. I have a high enough bmi (almost 49). It's so weird...normally i'd hide my bmi..on this site it's ok to shout it out, hehe. I'll let you know how the seminar goes...

I'm new here and i looked in the fill thread, but i'm a little confused on how a doctor fills you. I seem to be overlooking that... Do you just walk in and are able to walk out shortly after? i'm having a hard time picturing this...

Sorry for all the questions, but i was wondering how fast people typically lose ( i know it may be different for everyone). I have 150 or more to lose and was trying to get a range of how long it may take to lose if i get banded. thanks

thank you so much for you responses...the visuals really helped!!

Hi, I enrolled today in a seminar (on feb. 13th) in NJ to get more info on the lapband. I'm very over weight and too young to be feeling this way. I'm 28 and weigh about 290 (5'5) and i really need to do something. Any advice you may be able to give would be wonderful. Thanks