gina0922

I have the same issue in regards to the insurance changing. I currently have BCBSNJ which is changing to Aetna Jan 1st. I have done everything BCBS requested as well as what the Dr required. All my info/test results/documentation is with the Dr's insurance coordinator now. I am worried that my current insurance will try to stall me till it runs out. I have read where that is illegal for them to do that though. I have a 47.5 bmi and more co-morbidities than I want to even think about. If I am denied it will only be due to something someone forgot to include because I have done it ALL!!! Psyche, nutritionist, cardiac clearance after Angiogram, h pylori test, blood work, gall bladder ultra sound & chest xray. I even did an extra (7 in all) months of monitored diet just so they couldn't say I didn't have enough days in. One more thing I worry about (as if there weren't enough) is that I never had a regimented exercise program. I did what I could but w/COPD walking is pretty difficult at this weight. I do use my hand weights and my resistance band. Much of the exercise is in a chair. But it's moving. I can't afford a gym membership. I read Aetna required a supervised exercise program. Is that true? What's more is I don't even know if my employer chose to include or exclude wls in the new policy. They had it worded as "Medically Necessary" in the current one. Hopefully they have carried that over. If you have any suggestions or information, I would really appreciate it!

bumping this post...hoping to get an answer from someone

I am soooo nervous! My insurance is changing from BCBSNJ to Aetna Jan 1st. and who knows if it will be included or an exclusion in the new policy. I get the results from my cardiac clearance on Monday. Then everything that has not been submitted to the surgeon will be hopefully by the end of next week. Anyone know how long it takes the surgeons office to submit to the insurance? What is the "dictation" portion I have read about?

I didn't know that there was another Dr here in Palm Bay that did the LapBand other than Dr Fusco. Wow, I will pass that along to a lady I work with. She wants to have the LapBand but doesn't want to drive to Ocala. Did he have a huge program fee like Fusco? I just drove by PBCH yesterday for the first time since they broke ground for the addition. Wow! That's gonna be a really big hospital when it's all done. But they really did need it. I prefer PBCH over Holmes. I feel like I am just an Insurance # at Holmes. PBCH nurses were always so nice and friendly. I have decided to go with RNY. I have (hopefully) one last thing to conquer and that is an ECG and a stress test. I am now finishing up with a 10 course for H Pylori. One more blood test for that too. Then everything goes to the surgeon and off to BCBS. I had my consult w/the WLS 08/29 and at that point he was booked till mid to late Oct. So if I get a quick approval I am hoping to get a surgery date of early to mid Nov. How are you doing since the surgery? I hope everything is going well for you. Do you go to the Melbourne support group? It is for anyone pre or post wls. The next meeting is on 10/06 at the food court in the Melbourne Mall @ 6pm. I am planning on attending for a while. It will be my first group meeting. If you do decide to go you just have to look for a red headed woman with a green purse. :biggrin: Hope to see you.

Is she insane? :thumbup: Is she even hinting to you that you should stop taking your BP med? The reason for the surgery to to eliminate the need for the BP meds due to weight loss that comes from the surgery. That is like saying well you need to have a comorbidity like type 2 diabetes to be approved for surgery but if the med's your taking for the diabetes is controlling it, then you won't be approved because of the med's or insulin, you have normal blood sugar readings. What the hell is she talking about?? You really need to speak to the surgeon about that. She could cause someone some serious medical problems if they were to stop taking a needed prescription. :thumbup:

I didn't think I stopped breathing either. Not until my sleep test. I thought I was sleeping soundly. I found out when I went to my PCP for my next monthly weigh in that my results showed that I had right at 50 events an hour. :smile2: So you really never know till you take the sleep test. But I have to say that since I have started using the CPAP machine, it has made a world of difference in how I feel during my waking hours. I'm not falling asleep at work now or even when I stop at a red light! :tt2:

It's was a breeze for me! My psych required 4 visits over 4 weeks. They mainly consisted of her asking me a lot of questions regarding my life from as early as I can remember to present. What were my reasons for having the surgery. What type of support structure did I have in place after the surgery...blah...blah...blah. I answered honestly and it was all easy. I actually liked my sessions with her and may go ahead and keep going maybe once a month. My insurance pays for 20 visits a year. You'll be fine. Just be honest...they are trained to know when you are BS'ing them. Remember, they take notes and you may forget what you told them and if you lie they can catch you and may not approve you. I wouldn't want to take that chance.

CONGRATS!!!!!!!!! Sept 22 is my birthday! I will give you my birthday wish :biggrin: Wish for anything you like! LOL

I went to Fusco's seminar. When he through that $3700 "Program Fee" out there I knew he wasn't for me. I just don't have that kind of cash laying around and I can't see getting an equity loan for it either. Besides, per my Insurance I have to go to a "Center of Excellence" for my ins to pay "In-network" amounts. And the closest one is Dr. Jawad in Ocala, he also does lap band and he includes the cost of the fills in the surgical fee, so that the ins will cover it. He has no program fee either. Only a $250 consultation fee. My surgery will be there but my follow ups will be in Orlando. After the initial post op visit, I will only have to go every 6 months. For me the drive was worth saving the $$ that Fusco charges. I hear he is a good Bariatric Surgeon, I just couldn't afford him. I also decided that GBP was a better option for me after talking to my PCP. I have read many positive and many negative things about both surgeries, but for me, having to continually get the fills was just not something I wanted to do. I need the restriction all the time, because I know me. I would just say, "Well maybe I'll go next week for a fill". Something would happen and I would put it off. So a GBS is my choice. Best of luck to you!! How much have you lost?

I think he does prefer the RNY over the Band and he has done over a thousand of them and somewhere around 500 or so of the Lap Band surgeries. But as far as a bariatric surgeon, from what I have read and believe me I have done a lot of it, Dr. Jawad is rated #3 in the nation. Either way I think you would be in good hands. But if you found a WLS that you are happy with then you have made the best choice for you and that is what is the most important thing. Where are you in your process? Do you have a surgery date yet? I go to Dr. Jawad for my consult on 08/29. I have almost all of my pre surgery testing done. Last thing is my last weigh in on Sept 8th and my final psych visit 09/02. Then it off to the ins for approval. Whew! It's been a long 6 months!

Jetti, I am right there with you about getting it all done before seeing the surgeon. I will have my last psych appt on 09/02 and the last weigh in at the dr for my 6 month diet on 09/08. My appt w/the wls is on 08/29. I wanted to be completely done but the next appt available was around the third week in September and I didn't want to wait that long. I will take my results from my mamogram, sleep apnea test, pulminologist, gall bladder ultrasound and referral from my pcp with me and just send the rest when it's done and ready. I am so ready to get approved and get my surgery date!

Hi, my doctor wants me to stay on the 6 mo diet one more month because I actually gained weight (8 lbs) and although we discussed weight loss, she did not put in her notes (in my file) that we discussed WLS in March but did in April. Will this matter? I had my 1st consultation about weight loss with her in March. I have gone each month. I am like you in that I have had 6 documented of monthly weigh ins (03/07, 04/09, 05/07, 06/09, 07/09, 08/08). If we add one more month and show the start date of 04/09 and then weigh again 09/08 will I have to wait till Oct for it to be considered a 6 month supervised diet? I just don't want to have to go through an appeal process because of 1 extra weigh in. I have BCBS and they didn't require a 5 yr history.