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This was posted by an attorney on another site: If you don't want to do the six month diet, Options, or other pre-referral processes, APPEAL! The CA Dept. of Managed Health Care (DMHC) will order Kaiser to waive these requirements. This also applies to all heath insurers in the state. I have not been on an MD supervised diet in the last 3 years and when I submitted to Healthnet for approval for a lap rny I was terrified that I would have to do the six month diet. I was approved in 4 working days with no diet requirement. My bmi is barely 40. Good Luck!

Panda - when did you get your band placed? What happened the first time?:confused2:

:eek: I had my psych eval yesterday afternoon. It was with a psychologist that is approved by Healthnet and I only had to pay my $5 copay. We talked for about half and hour about surgery and my eating style (binge-grazer) and then I took a short evaluation for depression and a very long standardized assessment which was developed and normed expressively for weight loss surgery patients. It was the usual true/false questions but much of it seems aimed at self confidence/self image issues. After I finished the exam he told me that he would be recommending surgery! It turns out I was freaked out and worried for nothing. Good Luck in your journey to a healthier life!:thumbup:

Hi Cal Princess! I have Healthnet HMO and so far everything has been very easy. My PCP put in the request for authorization to see the surgeon (Dr. Waldrep in Sacramento) and it was approved in twenty-four hours. I attended the mandatory group appointment yesterday and the surgeon's office gave me the referrals for a chest xray, blood work, nutritionist and shrink. I have to return to my PCP for an EKG. After all those appointments are completed and the reports sent in to the surgeon, they will schedule me for the one on one with Dr. Waldrep and (hopefully) I will receive my surgery date! I asked about the six month diet with Healthnet since I don't have any doctor documented programs either, and the bariatric coordinator said she hasn't had that problem with Healthnet. There is a diet requirement that some surgeons may require if you are "apple shaped". I don't think I'm in that category, but I will be sent a letter if I'm required to participate in the pre-surgery diet group. I had my appointment with the nutritionist this morning and she explained all about the protein drinks for the weeks before and after surgery. The shrink appointment is on the 12th! I hope to have surgery right when school ends in June if good o'l Healthnet approves! Good Luck! April in Northern Cal

Hi Michelle! I have my group appointment on Thursday at SALSA. Could you give me an idea of what to expect? Also, what happens with Healthnet next? Thanks for any info. How are you doing with the band?

Hi Anne! I am too just beginning the process with Healthnet HMO. My PCP put in for referral authorization last Friday and I was approved that very day. She did not make me do any kind of diet before she put the request in. Maybe the diet will happen when I see the surgeon, I just don't know. (hopefully we won't have to do one at all before surgery!). I'll let you know how my Healthnet path is progressing and please let me know about yours! Congrats on your decision! April in Northern Cal:rolleyes:

I called my PCP and Healthnet today to check on my initial referral to get to see Dr. Waldrep at SALSA. The PCP's office said that they had submitted for authorization on the 18th. I then called Healthnet and the customer service rep very casually told me that I had been approved for the referral on the 18th and then she gave me the authorization code! I called back my PCP and asked them to please check their authorizations again and fax it over to the SALSA office so I can get started with the process. I only hope that when and if surgery is recommended that the approval is that quick and painless! The letter my PCP sent in to Healthnet must have been super.

You are so right Kathy! I think most of us have always focused on the LARGE numbers and not on the smaller "within reach" ones. I'm learning so much by reading this forum. Even though I'm still waiting for authorization just to get to the surgeon, I'm learning to appreciate every small step that I make on this long journey. One of the most useful things I've learned is to think of the band as a tool rather than the end all and be all that will solve all of my problems. I've been obese and severely obese for well over 20 years and changing my mindset is #1 for me right now. I tried not to obsess with the Healthnet authorization over the weekend, but now that I'm back at work, I'm freaking out again! Thanks for all of your great advice Kathy, keep it up!

Ducky - click on someone's ticker maker logo and it will take you to the site. After you have designed your ticker, it will give you a page with the code. copy the code with your edit feature and paste it into your sig line on lapbandtalk. Hope this helps!

Welcome Sassy! I just decided to try and have the surgery done with insurance pay. I'm scared to death, but I'm still going to pursue this route. I've been obese for 24 years. On March 6th I was there when my dear friend died from complications of obesity - COPD, high blood pressure, sleep apnea and diabetes. She was one month short of turning 66. I will be 55 on Thursday and even though I might have a long wait and fight to obtain this "tool", I'm up for the fight! You will never regret being there for your children. My daughter who is 23 is thrilled that I'm starting this journey. Good Luck!

Hi Christy! I found out this afternoon that my PCP submitted for approval to my medical group and not to Healthnet which is required. The patient coordinator at the surgeon's office called and left a detailed message for my PCP and then emailed me what she had done. I'm just in awe of her because I haven't even been approved to be seen at their office yet! I'm keeping my fingers crossed for both of us - I know the waiting is just horrific. I don't know about a diet - they are still playing tennis with my paperwork! As soon as I find out, I will post, and please let me know about your progress too.

There was a one page insert in our local newspaper (Sacramento Bee) on Monday the 14th. It was advertising a research study for obese people with bmi's from 30-35. The telephone number to call was 877-303-5264 and the website is Band3035.com When I clicked on the link, it took me to the website for a very reputable bariatric surgery group. The surgeon locations I found were in northern and southern California. My PCP said last week she had read in one of her Internal Medicine journals about this trial and also one dealing with lap band surgery in obese teenagers. Hope this is useful information!

Hi Allison! My process is exactly the opposite - I have to get pre-approval before I can make an appointment to see the surgical group! Your PCP will be supportive, after all you've done all of the hard stuff already. Let us know what your outcome is! April in Northern Cal.

Hi Sonia! It sounds to me like you are doing great!! 65 pounds lost in under a year is awesome, I only hope I can do as well when (not if!!) I get banded. Ask your doc or nutritionist about how to curb the carb cravings, I bet they have loads of suggestions. I hope your path gets easier to travel. April

Welcome Christy! I'm just starting my process and I'm also a low BMI person 5'7" and 255 with just barely 40 bmi, but with horrible degenerative lumbar disk disease and high blood pressure (which is totally controlled with medication). I'm still waiting for authorization to see the bariatric surgeon which hopefully will come today then it will be all of the tests before they will submit to Healthnet for final approval. Please let me know what you've been through, and Good Luck! I will keep positive thoughts for you...... April (in Northern California)

Lindabear, please don't feel alone! I'm just starting this process and reading the posts on LBT daily has really helped me to have hope and to not expect things to happen quickly, but to take it day by day. Have you talked to another surgeon at Kaiser about your surgery? I know that they do surgeries at the Oakland and Redwood City facilities too. There should be a Kaiser support group for lapbanders in the bay area and I'm sure they could give you the name of another physician you could contact. I'll keep you in my prayers!

There is a national study right now that is banding people with BMI's from 30-35. I saw the link on Dr. Waldrep's website when I downloaded some forms I needed to fill out. Your surgeon will have to be apart of the study group if you want to participate. The website is for Dr. Waldrep. The posting guru's don't let you put in full web addresses!:biggrin:<www.salsa.md> </www.salsa.md>

Hi Counting! Please don't worry about waking up during surgery. I spoke with my DBIL who is a neurosurgeon. He said that no matter what TV shows we watch on cable, he's never had a patient wake up in the OR unless he woke them up on purpose for nerve testing. He also indicated that it's routine to give meds for nausea in your IV before you leave the OR. Generally you also might get a dose of antibiotics too. I'll have to remember all of the stuff he told me so that when it's my turn to have my "big day", I won't bug him! Hope this helped a little.

I'm just beginning the process too, GOOD LUCK! All of the insurance hoops are daunting, but we have plenty of evidence that it can be done. Wow, how did you get your JD at 22? My daughter graduated from college at 22 and is now a 1L in Chicago. She won't graduate with her JD until she's 25. You must be one of the original Whiz Kids!

Just got back to school from my initial appointment with PCP. She is submitting for approval to Heathnet for me to be referred to Dr. Waldrep in Sacramento. Everyone, please keep good thoughts that I will be approved (at least for this first phase!).

Thanks Apple, I'm surfing over there as I type!

Happy 90 degree weather everyone! Just a few questions - I hope someone can help! I have my PCP appt. tomorrow to obtain my initial referral. I have to use Sutter Independent Physicians. I know there are two groups available right now, the one downtown and Dr. Waldrep (sp) in Roseville. Does anyone have a preference? Also, what surgery center do they use for the lap band, or do they perform it as an inpatient procedure? Thanks in advance for all of your suggestions!

Good Morning Everyone! I logged onto this great site yesterday, and your support gave me the confidence to start the process! I'm Healthnet California HMO through the school district I teach for and they emailed me that they do cover the band as long as I use Sutter physicians. I have an appointment with my internist on Monday for the referral. Currently I'm 5'7" and weigh 260, so I need to loose 120 pounds. I have high blood pressure and degenerative disc disease of the spine. I've had back surgery and I am scheduled for my 8th epidural steriod injection in May. What hoops will I have to jump through to get approved? My goal is to be able to wear a fashionable dress when my daughter graduates from law school in two years. Any help will be much appreicated!

Hi! I'm just starting my process too, but I'm in Sacramento. Good Luck on your paperwork. Keep us posted on your progress!