triser72

I have a student whose stepdad is a PS and they are going cash only b/c health insurance companies are paying them "pennies" for procedures. The insurance cos. discount all the rates, so the docs inflate the prices....and so it goes.... My husband's psych is charging him $5 for every prescription refill that has to be written - they call it medication mgmt and the insurance co. said they can't prohibit them from doing it. If we want the meds, we pay $5 for a med tech to write the prescription on a pre-signed piece of paper. Insurance on a Conveyor Belt......good times.

Lady zique - I have UHC Choice Plus through a Houston area school district. It's covered 80/20 for me and very few hoops to jump through, and my surgeon has not added any additional hoops either. I went through Memorial Hermann - it's a one stop shopping outfit for wls and UHC provider. My psych recommended MHHS b/c they have a excellent reputation for good post-op patient care. I went to the wls seminar at the end of February, met with surgeon in mid-March, did the nutrition class at MHHS and psych eval that same week. The surgeon's bariatric coordinator submitted everything on April 2 - she said UHC takes 2-6 weeks for approvals. UHC recognized it in their system on April 8. UHC Care Coordination of Dallas verified approval with a precert. # on May 7 and my second pre-op appt with the surgeon is this week. I am hoping to set a surgery date when I meet with him. Good luck!

I paid $175 for a social worker/licensed counselor to do my psych eval.

One of my favorite quotes (that I picked up from Reader's Digest about 20 years ago) is "People change and forget to tell each other." With wls - things will change, so you just have to keep talking about it. As you lose weight, keep talking about how your perspective changes in all parts of your life. Her perspective is changing, too. Confronting her - good for you! The fact that she responded honestly - even better! Only good can come from this situation. Don't let go of a good thing.

Is the Realize band the one that is 360 degrees and 10cc's or more?

It is good that you got some clarification - Thursday must have been a very confusing day for you! I think it is a good thing that the psych wanted to be available to you post-op. It's a major life change, so it warrants "going forward" discussions.

LOL!!! I think I have been on that tour for about a month now. I know my husband thinks he needs to be on it - "I sure am gonna miss your cookin'!" But this week, I realized that I am mentally tired of FOOD!

Thanks for sharing your experience! This is a wonderful account of the first couple of days!

OK - I am not sure what to do here. Any advice...would be appreciated...I called April 23 to UHC and the Claims rep told me that I was approved for bariatric surgery as of 4:45pm. Yeah! Yippee! Woohoo! So, I called April 30 to find out if a letter had been sent to me regarding the approval. UHC Claims Dept. told me that yes I was approved and my surgery date was May 6 and they were looking at the notification number. But they didn't know why documentation had not been sent to me regarding the approval. WHAT?!?!?!? :confused2: I didn't even schedule surgery b/c my surg told me that I needed a precertification # in order to schedule a preop appt and surgery date. I asked the Claims rep "Are you expecting me to be in the hospital on this date having this procedure done?" The response was, "Based on our information, you will be." REALLY?!?!?! So, the Claims rep transferred me to Care Coordination for further clarification. Care Coordination said "No, you have not been approved yet. Your file is still under review. We don't work in the same system as Claims." WHAT?!?!?!?! :confused2: So, I hung up with Care Coordination and called Claims again. Suddenly, they are confused and couldn't find the approval or if any documentation of approval had been sent to me. :wub: I want to know whose desk my paperwork is sitting on and what that person's direct phone number is at their desk. Any suggestions...????

I guess a Care Coordinator would help. I'll call tomorrow and ask if one has been assigned to me.

My surgeon faxed the pprwk to insurance. He and his bariatric coordinator advised me "to stay on top" of the progress with the insurance - he said the paperwork often gets lost if someone doesn't call to check up on it. Plus, he said "It's your money that is being paid to the insurance company. You have a right to ask what is happening."

Thanks for posting this! I have UHC and a similar timeline as yours, so this lets me know that I should expect the approval letter next week. My surgeon's bariatric coord. told me to call when I rec'd it to setup the pre-op appt.. YEAH!

Definitely go for documentation! Until then....have you tried...Aquaphor by Eucerin or Burt's Bees Diaper Ointment or Desitin? My doctor told me on skin fold rashes - always wet instead of dry - meaning an ointment is better than a powder.

I am doing my happy dance cuz I am approved for LapBand :biggrin2:and I have been accepted to graduate school:thumbup:!!! Dr. Ballette's office sent in the pprwk on 4/2, UHC rec'd it on 4/8. I have spent the past 3 days calling UHC - getting boomerang'd between Customer Service and Care Coordination is no fun :redface: - the right hand doesn't know what the left hand is doing in the world of health insurance. I finally yelled at a sweet young woman yesterday b/c in 30 minutes I was bumped btwn 6 dif't people in Cust. Svc. and Care Coor. with 3 dead-ends. I am paying UHC $400 each month to handle my health coverage and my paperwork is sitting in a pile on someone's desk and the computer, of course, has no knowledge of it:confused2:. So, I called today at 4:45p. Lo and behold, I have been approved!

Just tell her. We pay therapists to listen to the good/bad/ugly parts of our lives. They help us get through the bad and ugly parts, and rejoice with us in the good parts.

This is a great testimonial!!!

The doctor's nurse called me today to tell me the same thing - she submitted all of my paperwork for approval and to call the insurance company in 10 days and starting hounding them. Yippee!!!!

I have UHC - not banded yet - just waiting....the doc's office is submitting paperwk to them this week. I have heard that UHC is one of the quickest approvals out there, and that they cover more than the 80/20 rule. As to what my doc requires - he doesn't require anything the insurance doesn't require. So, no pre-op diet or battery of medical tests for me! Just a psych & nutrition eval with all my doctors records (which states a 5 year history of morbid obesity and co-morbities). All of this is what the insurance rep told me. I think getting the medical records sent to the surgeon's office was the hardest part so far.

rotfl.....I must have been gobsmacked at birth with that canned multipurpose dough!!! It's all on my butt!

:smile: I HATE MINE TOO!!!!!! Nationwide Medical keeps sending me extra supplies and I can't figure out how to get rid of the machine! I can't sleep with that stupid mask and I have to make sure I kiss DH goodnight before I put it on, then the mask comes off during the night. UGH!!! I just went back to BreatheRight strips and that seems to work just fine.

I think the best thing I read was last night (somewhere on this site) that Lap-Band is a weight loss TOOL. That made so much sense to me. I need something to aid in my quest for portion control - it's the holy grail for me. I am in the approval process right now, so I still have a bit of ignorance and innocence about the actual experience post-op. I see the restriction in the diets, and I see the things are going to be really tough for me to change. Like you, I was scared about 10 months ago, now I have a whole bunch of bravado!