Maggie225

Leslie called me Thursday and told me my insurance denied my surgery (I have UHC) and when she asked them why, the lady said I didn't meet the criteria, when Leslie asked what the criteria was, the lady became agitated and told her she couldn't give her that info, so I got on the UHC website and found the policy for Bariatric surgery and it said: " Bariatric surgery is proven for the following: Class III obese (BMI > 40 kg/m2) Class II obese (BMI 35-39.9 kg/m2) in the presence of one or more of the following comorbidities: Type 2 diabetes Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina pectoris, hypertension or coronary artery bypass) Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy) My BMI is over 35 and I have type 2 diabetes, plus GERD and High Cholesterol, so I'm not sure how they could have denied it. Leslie said that Dr Posner would have a one on one peer review with my insurances review Dr so hopefully it can get approved, especially since I have already had all my pre surgery tests done and my surgery date is May 4th. So everyone cross their fingers and toes for me:confused:

Ok, so BGH called today and stated I have an appointment on April 8th....OMG...I told her "NO" my appointment is April 23rd for my last weigh in before surgery which is May 4th, then she said yes I have you scheduled for that day (April 23rd) so where did they get April 8th??? I also found out that my appointment in Jan. that was billed to my insurance was not me and wasn't even Dr Posner...what is wrong with that office. If I wasn't this far along in the process I would definitely change Dr's and facility, but I've come this far and it has taken me almost a year, so I hate to start over......GGGrrrrrrrr I really have a problem with incompetent people and it certainly makes me more nervous about the surgery.:thumbup: Okay I'm done venting now, hope everyone else has a great day:smile:

Actually this whole process has taken longer than I expected (so you would think I would be ready by now...LOL) I got the application and sent ALL my paperwork (Dr's notes, letter from my doctor, etc.) in June 2009, I had my phsyc evail done in Aug (on my own) and still never got into a seminar until November and then I never had my 3 hr meeting with Barb until 01/28/10. So this whole process has almost taken me a year, and as of now I'm still waiting to see if they can get the insurance to approve it. Did it take this long for everyone else?? Maybe I'm just an impatient person :wub: LOL And does anyone else think the office is chaotic, my appointment was at 1:45 and Dr Posner never came in until after 2:00 then someone came in and got him for a meeting, so I waited and it was near 4:00 before I got out of there, and i wont even mention what happened with the billing last time I was in there :sad: But Melissa is fixing that, Thank God

I was in and saw Dr Posner for my consultation on March 8th and he set a surgery date of May 4, 2010. I didn't think I would be this nervous, did anyone else get cold feet or is it just me?

I LOVE your tattoo Jenn :smile2: Thanks for sharing it with us.

I absolutely love moons and stars. I've been thinking about getting another tattoo but I fugured I would let that be my reward after I lose some weight:smile2:

Mkat, I also had to take that true/false test and by the end of the 589 questions I was beginning to think I was crazy:blink:. The questions were outragous. I went to a local lady here where I live and I wasn't to impressed with her either. She seemed to be bothered with the whole process, go figure...she could have been a little more friendly or atleast pretend especially since I had to pay her $175.00 for the 2 hours I was there:mad: I am glad to have it all over and done with and hopefully the results come back that I'm not insane and can have the lap band surgery...LOL

Hello all, it's been awhile since I've posted on here so I figured I would let everyone know where I was at in this process. I have my psych exam today at 1:00, and I'm still waiting for my paper to see what day the seminar is this month (they told me when I went in in Aug that I was signed up for the sept. seminar so I hope they didn't forget about me) I am so excited to get this ball moving a little faster. I need to go back and weigh in again, so I can start the SB diet, but I wanted to wait and see when the seminar is so I only have to make one trip(but if it's not till the end of the month I better go in sooner :blushing: Hope everyone has a great day:rolleyes2:

I am signed up for the Sept. Seminar, WOOT, WOOT:thumbup: I have a question though. Does everyone have to have a sleep study done before the surgery or is it only the one's that may have sleep apnea? If it is a requirement I want to go ahead and get it done now. Dr hoffmans office gave me the form for the psych exam so I'm going to get that done ASAP, I just want to make sure I get everything I need done before the seminar so hopefully this process goes as smooth as possible.

I sent my paperwork in last week and haven't heard anything back yet. Should I call Dr Hoffman's office? Could someone give me the number (including the area code please) I just really want to make sure the ball keeps rolling here. Thanks :tongue_smilie:

Shar, I am just sending in my paperwork, so as of now I dont have a consult date yet, but I will keep you all posted:smile: I really hope this goes quickly. Do you have to go to a seminar before the consult with Dr Hoffman? The paperwork says they will call or send a letter telling me when the next seminar is, how long did this take everyone to get?

I also need to lose 85 lbs. and I would be more than happy if that happened within a year. I have not been banded yet and I'm still concerned my insurance wont cover it. I'm 230 lbs 5'7" with a BMI of 36. I will be sending my packet of paperwork to the surgeon's office tomorrow, so hopefully I will get a consult and be eligible for the lap band surgery. I have been very thorough to dot all the I's and cross all the T's so hopefully this process wont take too long. Keep your fingers crossed for me :thumbup:

I am so excited, I just returned from my Dr's office with good news. I had taken the liberty to write a "sample" referral letter for my PCP and when I got to his office he said it was the best written letter he had ever seen and asked if he could just copy and sign it....YAY...(I am a certified medical coder, so I used CPT codes and I think I did a fine job on the letter *pats myself on back*) :thumbup: I was afraid he would not refer me for the lap band but he thought it was a good idea, so for now I'm on cloud nine. I have all my paperwork in order now and I'll be mailing it back to Dr Hoffmans office tomorrow, so hopefully this goes smoothly. I'm keeping my fingers crossed. And another good thing happened, my Dr said that if they require a sleep study, he would be more than happy to do that (since he is the sleep study Dr at our local hospital) now how lucky is that, my PCP is also a sleep study Dr. I think this is truly meant to happen for me, all the pieces seem to be going into place. Hope everyone else has a great day too.

Thank you all for posting to this thread. After reading everyone's stories I feel much better. I am currently 5'7" and weigh 230 lbs which puts me at a BMI of 36, but for the past few years my weight has gone up and down and at times was under a BMI of 35, so I am extremely nervous that my insurance will not pay because I have gone below the 35. but now I think I might still be able to have this surgery in Mexico (at a reasonable price) if my insurance turns me down. You all give me hope, thanks again:smile2:

I received my application from BGH. I got most of it filled out but I need some dates from my PCP files (because I can never remember dates) so I called his office today and requested my complete chart to be copied so I can make sure everything I need can be sent together (whats that saying "if you want something done right, do it yourself":rolleyes2:) I really want to make sure I have all my ducks in a row before I send in my application and hopefully that will save me time in the long run, plus I would feel much better having my chart handy so I can make copies if I need them. I am trying not to get too excited but I really want and need this surgery:thumbup: Everybody keep your fingers crossed for me

I have been on here for the last few months and I am still trying to decide where to go for the Lap Band. I am about 2 1/2 hrs from Buffalo, but I have heard so many good things about Dr Hoffman that I am considering going there. I have read on here that I need to call and get an application, but I was wondering what other info Dr Hoffman requires? My other concern is that I only have a BMI of 35.2, but I do have Diabetes, PCOS, GERD and COPD (which I'm not sure if those are comorbidities or not) I have United Health Care Insurance and I do have documentation of a 6 month low calorie diet that was suppervised by my Dr about 4 years ago, so I'm not sure if they will except that. Plus my BMI has gone up and down over the past 5 years (so at times my BMI has not been above 35) I have always weighed over 200 lbs, but I'm 5'7". Has anyone else gotten approval with a similar health record? Sorry this was so long, I just have so many questions and my fear of getting denied by my insurance is standing in my way right now.

I am checking into Lap-Band surgeons in my area and Arnot Ogden in Horseheads NY is the closest Hospital with a Doctor that does the band. The doctor is Dr. Subramaniam Sadhasivam and he is covered under my insurance UHC. I am going to look into some other doctors in the Buffalo NY area because I am about 2-2 1/2 hrs from there. Any suggestions???? Thanks "Revised" I also found 2 other Dr's at Arnot Ogden Dr Robert E Cole and Dr Douglas Mckane I did a search for Dr Moon but he apparently is no longer at Arnot Ogden

Thank you Mary. I feel better knowing Dr Rahman comes highly recommended. Let me know how your consultation goes with him. Good Luck:thumbup: I am about 1 1/2hrs away from Arnot. I'm still in the process of getting my PCP to do the paperwork. Thanks again for the reply

I called my insurance today (United Healthcare) and Lap Band is covered at 90% which is awesome but then I was told I have no Bariatric Resource coverage, which I guess is just a service some employers pay extra for, it covers having a team find you a doctor and I guess they work with you and help you understand the procedure, aftercare, etc. I'm guessing this is no big deal because I have already found a surgeon close to me (1 1/2 hrs drive away) and I'm sure he will give me the info on the surgery, etc right? And this surgeon is in my network so there shouldn't be any problems. The question I do have is; when I asked what the guidelines were for the lap band all the lady could give me was the "generic" version off something she was reading, she stated you must be obese and have health problems relating to the obesity, she did not give me any BMI numbers or anything???? When I visit my PCP and he sends me to the surgeon will they be able to get all the guidelines? I really wanted something in writing to take to my Dr. so he could see the guidelines. Well I guess I'll just go and if I get denied I'll appeal it.:laugh:

(I posted this on another thread before I found this one) I have an appointment today with my PCP and I'm going to ask about getting the lap band. I am sooo afraid he will tell me I'm not fat enough.....it seems weird to me to say that because I have been overweight my ENTIRE life, but my BMI is just over 35. I have always weighed over 200lbs but again I'm afraid he will tell me I'm not a good candidate for the surgery I do have diabetes type II and PCOS and knee problems and I've also been on 4 different prescription meds for weight loss with no success. I guess I'm just posting this to try to relieve some of my anxiety because I really, really want this surgery. I would love to hear from anyone who has a BMI of 35 that has been banded and anyone else that wants to jump in here too:cool2:

Thank you Band Groupie:smile: I am in Genesee PA which is at the very top of the state next to the NY border, I did call my Insurance and I am covered if I have a BMI of 35 with 2 co-morbidities(sp?) I'm not sure if I would have to do the 6 month diet or not. Was that required from your ins or surgeon? I did look into LB doctors in my area and there are 2 at Arnot Ogden Medical in Horseheads NY which is a about 1 1/2 hr drive for me (and both doctors and the hospital are in my insurance network) I have UHC ins. and from what I've read on the forums most of the people with UHC have to submit 6 weights (over the 35 BMI) for the last 2 years, which scares me because I have dieted so much that I'm not sure if my BMI was 35 at any of those office visits. Sometimes it feels like I take 1 step forward and 2 steps back:cursing: Thank you for your wonderful suggestions and support, I really do appreciate it. I will keep you all posted, because I am not giving up without a fight:rolleyes:

First of all I have to say to Band Groupie, I loved your blog. I have been doing the same thing you did, I have ate everything in sight for the last 2 weeks to get to the 35 BMI and I agree with you "its not fun when your trying to gain wait, I made myself sick a couple of times...LOL Anyways, I had my appointment yesterday and my Dr is sending me for more tests for my Diabetes, my OB/GYN has been monitoring it for the last year but has not put me on any meds and my PCP was a little upset that nothing more was done for me (he's a great guy and very knowledgable) so I guess I am going to have a 3 hr glucose test and a kidney function test done. My Dr did tell me that the medicine that he plans to put me on will help me lose weight but when I asked him how much, he laughed and said probably not as much as I wanted. I did discuss the lap band with him and he did comment on how much I had researched it, he said he wanted to focus on the diabetes first (which is understandable) and then we can see where my weight goes from there. I am certainly not giving up and I figure every visit to him gives me another documented weight on file, right?:tt2:

I have an appointment today with my PCP and I'm going to ask about getting the lap band. I am sooo afraid he will tell me I'm not fat enough.....it seems weird to me to say that because I have been overweight my ENTIRE life, but my BMI is just over 35. I have always weighed over 200lbs but again I'm afraid he will tell me I'm not a good candidate for the surgery:confused: I do have diabetes type II and PCOS and knee problems and I've also been on 4 different prescription meds for weight loss with no success. I guess I'm just posting this to try to relieve some of my anxiety because I really, really want this surgery. I would love to hear from anyone who has a BMI of 35 that has been banded and anyone else that wants to jump in here too:cool2:

Thank you Jodi, your comment makes me feel much better. My appointment isn't until 4:30 today and as the time passes I seem to feel more relaxed. I really hope my Doc and Ins will both agree that this is a medically needed surgery:cool2:

I went to the Lap-Band website and did a search for certified Lap Band doctors and found there are 2 at Arnot Ogden in Horseheads, NY I think I will go with Dr. Anishur Rahman the other doctor certified for the lap band was the Dr. I mentioned above Dr. Subramaniam Sadhasivam (boy thats a mouthfull :thumbup:) Well anyways I figured I would post them on here in case anyone else was looking for a certified Lap-Band doctor in this area:thumbup: