nursenky9

Does alcohol affect u differently after lapband? It does after the RNY, the RNY folks drink much less after the surgery they say it buzzes them faster. Just wondering

My surgeon's nurse practitioner reported to me that the surgeon instills saline into both bands and on some pts he does not instill. She reported it is an individual case.

I am going back to the supervised WL again and this will be an additional 2 months of supervised wt loss diet. I do not know what they are wanting for the supervised wt loss diet. Yes I am about to give up. It will be 3 mo on Sept 7. I just want to get the wt off I get short of breath walking and occasionally have chest pain with walking (angina). On top of this my house caught fire on Aug 20. But my daughters and I are ok. I get angry over the denial and when I think about quitting I think about being denied and get mad and that is what keeps me determined to loose wt. Other people it seems like get approved in no time and others take for ever. I think they feel if they deny we will give up and quit. Good luck and keep me posted. Elizabeth

I have BCBS PPO of PA and they denied me on 8/15/08. Very frustrating. Good luck to all!! ET.

pre-determination is were the surgeon's office submits all the paperwork to your ins. and a nurse or MD reviews it for medical necessity and to determine if it meets criteria. If it does the ins will pay for the surgery if it doesn't the ins will not pay. The surgeon wants to know this because it is the reimbursement.

Yes it gets very frustrating!! The ins. co. said they did not receive the psych eval, nutrition, or the Supervised WL. So I will be contacting the surgeon's office to find out what they did submit. BCBS closed the first one out that was submitted on 7/7/08. The surgeon's office resubmitted and the ins. co received it on 7/25. I am thinking that the surgeon's office did not resubmit all the information that again they thought they would use the info they already had. Good luck!!

Have u heard anything from Highmark yet? I just found out today that Highmark denied my surgery. Good luck!! I will talk with the surgeon on Monday to see what is going on. The ins co told me that it wasn't medically necessary, they did not have the medical records such as the psych eval nutrition, and supervised wt loss. I had 7 months of supervised WL. Best of Luck!!

I called my insurance co today and they said I was denied. They reported it as not being medically necessary. They also told me that they did not receive a psychological eval, nutrition, or the supervised WLS. I went through the psych eval and nutrition class. I don't know what's up with that. I am wondering if when the surgeon's office resubmitted if they did not resubmit all the paperwork since the ins company had some of the papers already. They said they needed the medical record. That the surgeon sent a letter and not the evals. What did your doc send to them? You got approved so quick!! That is awesome!! What did u use for the WLS? I went to a wt loss clinic. called Total Med were they gave me Phentermine and B12 injections weekly. Ageless WT Loss center were they gave me phentermine and counselors. I will contact the surgeon's office on Monday to see what is going on. Very discouraging.

I have highmark bcbs and my ins received my info on 7/7/08. The precert said they would return a reply within 15 days. Today is the 18th of July and they contacted my surgeon re: the docs name at the wt loss clinic so I gave that info to them. This ins has a 6mo wt loss cumulative within 2 years of the request. I have wt watchers, curves, LA wt loss, Ageless WT loss center- the physician they asked for, Total Med-I saw a nurse practitioner and she prescribed meds. I have 10 months worth and my PCP referral letter stating recommend lapband d/t comorbidity of high lipids joint problems. My BMI is 39. I am hoping this doesn't mean they are going to try and deny me. Anyone else had any dealings with highmark bcbs? I work for chain of hosp. and this is the ins we have. It has been great for every thing else. Thanks, ET:unsure:

Good luck to all of us!!! I am still pending as of today. Tomorrow will be 3 wks since resubmitting. I started back to Total Med which is a supervised WL center. Nurse

My ins. co received paperwork on 7/7/08. On 7/23/08 my surgeon contacted me and told me that the ins co said they could not use the first MDs note because it was over 2 yrs old. 6/26/06, or were I saw the counselors there after for the month for my diet counseling wt in etc. I would like to know what all do u have to have for the ins? My ins is BCBS PPO Highmark, they say at least 6mo supervised WL diet for a cumulative of at least 6mo over the 2 yrs prior to surgery. I had a copy of my ins policy and it says that it takes physician supervised or counselors, exercise that is working under the MD supervision. They would not count the mo of LA wt loss or weight watchers that I was doing. It appears they only want to look at diet supervision when the doc prescribes phentermine. Any suggestions or has anyone encountered this? I had 4 mo of MDs and diet pills they were ok. I submitted 3 mo of my PCP notes that had "concerned about wt" or "wt gain" the last was "re lapband" under the diagnosis had wt gain, wt gain, obesity for the plan she wrote: labs, increase exercise calorie restriction, on the second one she orderd synthroid (even though my thyroid level was in normal range) to exercise and watch calories, on the 3rd not it was to follow low fat diet and exercise. Just hoping I don't get denied. Any comments would be greatly appreciated!! I have been at this process for some time now. Thanks, and good luck to everyone!!! :w00t:

Heather it is Aug 14, 2008 and still pending. When we resubmitted (they received it on July 25) the PCP's supervised wt loss surgery they said it could take up to 30 days. I have Highmark BCBS of PA which did u have? How are you doing? Are u just thrilled? Nurse

Good luck!! I have highmark BCBS they received paperwork on 7/7/08. On 7/23/08 they contacted my surgeon for one of the MDs name I went to for the supervised WL and additional mo of supervised WL. They received the info back on 7/25/08, still have not heard anything, my surgeons office told me they would call tomorrow if they didn't hear anything today. I went back to one of the Supervised WL docs today so that if they deny it I will have another mo. For whatever reason they prefer it appears this one over the others because they prescribel Phentermine. Good luck everyone!!

Yes I am a nurse. Still waiting on the approval from the insurance company. Aug 4 will be 4 weeks since the submission of paperwork to the ins co. I had to submit more PCP progress notes on last Fri. Hoping I get approval soon. They would not use my LA WT Loss or Wt watchers. ET

Dr. Schulman: Thanks for your response. I toured your website. Very nice work!! Thanks for all you do for the obese community.

Dr. Schulman: I had a TT back in 2003 along with a totl abd hysterectomy. I have gained alot wt since then, I am in the process of getting my ins approval for th band. Have u marketed your services to the surrounding bariatric clinics/surgeons? Does ins cover PS for WLS? I have Highmark BCBS PA they mentioned to me that reconstructive surgery is covered, the policy they sent me was just on the WLS

Dr. Oldham in Lex.

The ins company would not take several months of the diets. They would not use the LA wt loss or Wt Watchers. I have my PCP and am hoping they will allow it submitted this info on 7/25/08. Hoping to hear some positive news this week. ET

I had a TT in 2003. Went through alot and I have gained around 90 lbs since then. Waiting on ins approval for the band. Very good post! I was wondering about the TT pre band.

I have Highmark BCBS and I have had my paperwork submitted to the ins. co since 7/7 and just had to submit additional paperwork today. Good luck on your journey

My surgeon does the RNY, band, and the sleeve. I think that when an individual is dedicated to have a WLS procedure, they generally research the procedure, I know I sure have. I know that the RNY is not for me because of rearranging of sm intest, too invasive and also malabsorption, as one gets older this surgical procedure concerns me since elderly are already prone for malnutrition. The band is restrictive and since my main problem is the amt of food I consume, I read on the band and found that it would probably benefit me the most because of the type of over eater I am. I liked that it is adjustable. I am not with out fear because of the opening (stoma) is about the size of a dime, scares me about obstruction. The sleeve I like because even though most of the stomach is taken away, you don't have to worry about malabsorption and the wt loss is almost as well as with the rny. Also, my insurance still lists the sleeve as experimental and will not cover it. I will be getting banded as soon as my approval comes through b/c I can not afford self pay. I submitted the paper work on 7/7/08, and the contacted my surgeons office needing more on th supervised diet. So I took some info I had from my PCP and one of the wt loss clinics to the surgeons office today. Fingers crossed I will be approved the first of next week. I have Highmark BCBS.

I read on a forum or someplace about a woman that was banded and lost wt I think she had only been banded for 4 or 5 mo every thing turned out fine. When pregnant they unfill the band til after you have the baby then they start the fills again. Some women do the band in order to help get pregnant. you can google lap band and pregnant for info

I am from E. KY live in Lex now. I am assigned to Dr. Oldham. Haven't met him yet. The seminar, Dr. Weiss did. Do u know anything about Dr. Oldham? I am having to submit more MD progress notes to ins tomorrow. the 21st will be 3 weeks sinc I submitted my paperwork.