juliansmom2003

Wow, how exciting! Lots of luck to all of you that are being banded this week! I hope all goes well and can't wait to hear how you're feeling!!

Congrats on the first step! I attended my seminar last week and left SO excited to get started!!! I was told it typically takes about 3 or 4 weeks to get that initial consult with the surgeon after the seminar, but I got lucky and my consult is this Friday (they had a cancellation right before I called!!!) I'll also be going through the insurance approval process during this time as well, so wishing you luck on that part!! (I'mReady--hope you enjoyed your seminar last night as well!) Here's to the start of our great journeys!!!:biggrin:

I was worried about the exact same thing. I asked the admin at my surgeon's office who assists with the insurance approvals and as long as your primary supports you, writes you the letter of medical necessity, as long as you're participating in a supervised program prior to the surgery, you should be fine. There is a sample letter of medical necessity on the Lap Band site, but the doc can mention that you've made several attempts to lose the weight (Atkins, slimfast, etc.) to no avail. Believe me, they don't expect us to consult our docs when we decide to go on slim fast LOL. Hope this helps! Good luck next week!

I am so excited after attending the Lap Band seminar last week -- my first official step!! The surgeon mentioned not to get discouraged because it could take a few weeks before being able to get an appointment, but I got REALLY lucky when calling yesterday. They had a cancellation for THIS Friday morning, so I snatched that appointment right up :-)! The next step after going to this consult is to contact New Beginnings (their pre-op program) to make my initial consultation with them. I was wondering--does anyone know when a surgery date would be assigned or when the insurance approval process begins? I know everyone is different and I plan on asking at my appointment from Friday, but I'm just trying to at least get a sense for how it works. I have to pay $1,450 out of pocket for the pre-op program, which my insurance doesn't cover, so I'm hoping they don't wait for me to go through that first to then get declined from my insurance company because I simply cannot afford to pay out of pocket for the procedure. I have Keystone Health Plan East (Blue Cross Blue Shield)-PPO Plan. Does anyone have any insight into this?

Oh yes, my insurance requires the three-month supervised program (the New Beginnings that the surgeon makes us do). That is the actual requirement, so I'm thinking that after I complete that, then they submit everything for approval? My thing is that I don't want to fork over that much money if they aren't going to approve it, but I guess as long as I go through the program, why would they deny me? LOL, I think I may have just answered my own question. Thanks for responding!

Okay, so in completing all my paperwork for my initial consult with the surgeon, I notice they want me to record the type of food I've eaten for the 2 days before the appointment. Now that I've written it down (today would be day 1) , I notice that I'm not snacking between meals. It's things like these that make me question how the lap band will help me if it doesn't look like I'm eating a lot, you know? Am I even making sense? I just want to be sure that I am in fact a good candidate for the procedure. I meet all the insurance requirements (BMI, etc.), but will this help me if I'm not really overeating? Does anyone have any insight into this that you could help me with?

Hmmm, I'm not sure how STD works (if it's state paid, I imagine it would vary by state). I do think there's a minimum amount of time you need to be out in order to take it though. I'm hoping a week vacation and a week working from home might be my solution to this....do you have the option to work from home at all?

Sheesh, does that include the surgery?!? Seriously, that sounds really high to me. My program is $1,450, but includes pre and post op support groups, all testing, psych, nutritionist and additional testing. I know any medical expense over $1,000 is typically tax deductible, but that doesn't help right now. Any way you can research other surgeons to see what else is available to you?

Thanks for posting, Tia! It's wonderful to hear that you had a good experience with the actual surgery part. I am thinking I have a longer way to go that most of the people on here. My seminar is next week, so these fears haven't hit me just yet. I'll remember this post when I'm getting closer to surgery though! Thanks again for sharing and lots of luck on the road to "skinny" :-)!

Congratulations, everyone! I'm so happy for you all! I can't wait to hear updates as you continue on your journey!!! :smile2:

So, I haven't even had my initial consult yet with the surgeon (seminar is July 2 and they won't let me schedule the consult until after I attend the seminar), but I am wondering about the pre-op diet and nutritionist that is part of the pre-op process/insurance approval requirements. If you end up losing weight, do they then discourage you from the surgery? I'm just curious to see how it went for those who have lost weight as a result of the pre-op nutritionist advice/dietary restrictions? I'm just worried that somehow, I'll be given a "no" at some point. Thanks for any insight!

Sorry it's Keystone Health Plan East (PA). Thanks!

Congratulations!!!! How exciting! I'm just starting the journey. After a month or two of research, I am raring to go, but the next seminar my doctor is doing is on July 2 because he's on vacation and I can't schedule my consultation until after I attend the seminar!!!! Seeing posts like these for those who are ready to go just really gets me even more excited! Please keep us posted on everything! Lots of luck next week!!!

So, now that I have registered for my seminar, I have been obsessively researching the doctor, the hospital, the insurance approval process and the hidden costs I might be hit with unexpectedly that might delay my surgery because I am sooooo ready! In obtaining the insurance requirements from Keystone Health Plan East (Blue Cross PPO), I noticed that there needs to be confirmation of failed attempts at medically supervised diets/weight loss plans. I saw my primary physician last week and she said she'd write the letter of medical necessity, I have a BMI of 43.5, and I have to attend this New Beginnings program, since my surgeon (Adam Goldstein) is part of the Virtua healthcare system. My question is this: would it be sufficient for the doctor to include in her letter that I have failed several attempts to lose weight or are they looking in my file for specific medically-diagnosed weight loss plans? I meet every single item in the criteria, and would be crushed if I hit a snag like this and can't get it covered (no way I'd be able to do self pay for this). Can anyone help clarify the medically supervised item for me? Thanks SO much!!!

Hi Lisw55. First congratulations to you on your surgery. How very exciting for you!! I'm in Burlington County and considering Dr Adam Goldstein or Dr Kipnis. Obviously I want to be as prepared as possible with out of pocket expense, and I'm sure my keystone won't cover New Beginnings, so if you don't mind, could you share with me the cost? Do they take a payment plan? Thanks for any details you can provide. Lots of luck losing :-)!

OMG these posts really hit home for me. My husband constantly says how much he loves me the way I am, how he loves my body and curves, that I don't need surgery--we just need to eat better and exercise more (mind you, he is as thin as a rail and doesn't gain weight :confused:). I went last week for an appointment with my primary to get her thoughts on me being a candidate for this and she couldn't agree more. I am currently 100 lbs overweight and have diabetes, bp issues and heart disease on both sides of my family as well. When I told her the surgeon I was considering, she gave him rave reviews and told me she'd provide the letter of necessity for the insurance to cover it. Even after that appointment and telling my husband what my doctor said in agreement and the process I would need to follow pre-surgery, he still told me that he'd be supportive of whatever my decision was, but he didn't think this was something I needed to do. I really think that some of the hubbies may not 'get it' if they are not in the same situation. The mentality is----to lose weight, just diet and exercise and it will come off, but for some of us that have been on this roller coaster all of our lives, that is just not the case. Hang in there. You have a great forum for support and a bunch of people not only going through the same thing, but will be there to help whenever you need it. ((HUGS))

Hi! Congrats on your surgery date! How exciting! I too am 5'1 and 230 (about 6 years older than you though). May I ask how much you'd like to lose? I'm hoping and praying for 80 to 90 lbs, but I have been reading that the average results are about 50% of the weight overage? I'm trying to figure out if that is the case with 'real' people though LOL I'm so glad I found this board. Even though I have a great support system, none of them are going through it with me. To have a whole group of people going through the same thing to chat with is just such a blessing! Lots of luck on the surgery!!!

I must say that I am thrilled that I found this group! It's been great researching the surgery and all the details from an informational standpoint, but I think I need to hear about 'real' people's experiences, since this is such a big step in my life. That said, I want to introduce myself. I'm Karen, 35 (will be 36 soon) from Philadelphia, married with 2 kiddies (ages 5 and 3). I have been on a serious weight loss/gain rollercoaster practically my whole life and have been researching Lap Band for about 2 months now. I saw my primary physician on Friday and she is very supportive of my decision to have the surgery and has agreed to write the letter of medical necessity so my insurance will cover the procedure. I go for my seminar on July 2 and from there, I am able to make my initial appointment with the surgeon. I am 5'1 and 230 (BMI of 43.5). I have been reading through these posts and I must say how thrilled I am at how supportive everyone is. I feel like I've found a great place here!! I have so many questions, so I'm just steady writing them down for the surgeon, as I can see from reading these posts that doctors can be really different. I do have a question that I was hoping someone could answer about insurance-paid procedures. Are the fills also covered or are these out of pocket expenses? I currently have my benefits manager looking into it, but just wanted to see what the consensus is here. I'm really looking forward to this amazing journey and getting to know everyone better! Lots of luck to everyone pre-op, post-op or even if you're just considering getting banded! Karen

Hi Bobbie! I'm new here too! My seminar is scheduled for July (doc is going out of town or else I'd be in there next week). I've been researching the surgery for so many months that I'm just raring to get started! You gals are very lucky to have supportive husbands! While mine will support me with whatever I decide to do (duh! I'm having the surgery! LOL), he doesn't feel like I need it. He says that I'm perfect the way I am and he doesn't want me to change a thing. The issue is I don't like myself the way I am and if I don't change, I don't think I ever will, so that trumps how he feels LOL. Anyway, I'm really looking forward to getting to know everyone and having the support I need from people that are going through the same thing!

Tizzylish, did the insurance company give you a reason that they wouldn't cover it? Is it that they just don't cover WLS or would it make a difference if your doctor wrote a letter of medical necessity and a surgeon was able to confirm that you are a perfect candidate for this? Perhaps they have other weight loss/healthy lifestyle programs you can try before taking this step? I did a search online and here is a great reference resource I found. Maybe it will help you: http://www.lapband.us/lap-band-insurance.html ITA with the previous poster. Go somewhere that you know no one, put on the suit and a t-shirt. Your kids won't care one bit and they are more important than any idiots out there that make you feel ashamed. ((HUGS)) Don't give up. This is a great forum and honestly, surrounding yourself with positive people and getting support like this while considering taking this step is major. DON'T GIVE UP! There is always a way.....

Well, I've been researching this surgery for a few months now and have finally accepted it has become a necessity. With my kids being so young, I want to do something now so when they get older, they won't be teased about having a fat mom. The prospect of having this surgery has brought me unbelievable hope. My doctor agrees with my decision and will provide her approval for insurance to cover the surgery, and I have a tremendous supporter in my mom. I just wish my husband agreed with this. While he is supportive of whatever my ultimate decision is, he feels that I don't need to do this and he loves me exactly the way I am right now. Well and good, but I don't love me the way I am right now..... Let the journey begin....