blondie12

Hello There~My Lap-Band story starts back in April of 2005, when after a couple of years of contemplating surgery, I finally decided to schedule a consultation with a bariatric surgeon.  It took a month to get the appt.  My intention was to go in and inquire about the Lap-Band, but I was quickly steered toward Bypass by the Surgeon.  He said that Bypass was better for me because of the amount of weight I had to loose and he also implied that due to my age (26 at the time) it wouldn't be a good idea to have a band inside of me for the remainder of my life...  At the time this sounded reasonable to me.  I started the process with this Surgeon's office and began taking mandatory classes for Bypass patients.  The classes were given by a an RN.  After about the 2nd class, I determined that Bypass was not for me.  I found myself in a room of 50 people ranging in ages from 40-60ish (again I was only 26) and felt like this was a last resort for most of them.  I figured that I was young and healthy enough to be successful with the Lap-Band and decided that the much too DANGEROUS & DRASTIC Bypass procedure was not for me.  I called the surgeon's office and told him what I felt and asked if I could be set up with a Surgeon who performed the Lap Band.  At that time I was told that none of the Surgeon's associated with my medical group performed the Lap Band.  I soon realized why I was so quickly referred for the Bypass...  I became very discouraged and decided to try to loose the weight on my own, AGAIN...February 2007 I attempted to see another Surgeon, who was not contracted with my medical group.  He was however on the list of providers for my insurance.  My medical group denied this referral stating that the service was available within my medical group.  They gave me another referral to the same Surgeon I had already seen.  My medical group doesn't do Lap-Bands, they only do bypass.  I appealed and was approved to see another physician who a friend had recommended to me.  He was not in my medical group, but he was a provider for my insurance.  I got an appt with him in December 2007.  He went over the Lap-Band procedure with me in detail and told me there were a couple of studies I needed to have done before I would be able to schedule a surgery date.  I proceeded to have the indicated tests and thought everything was smooth sailing until the time came to get the actual surgery approved.  After going back and forth with my medical group and my insurance, it was determined that my insurance would not cover the Lap-Band with this surgeon because he performed the surgeries at an outpatient surgery center.  My insurance stated they would only cover the surgery if it was done at a "Center Of Excellence".  In March 2008 I received an authorization to see a Surgeon at Cedar's (a CoE).  I met with him in May 2008 and was very happy, both with the surgeon as well as the office.  I had done most of the required studies and therefore was able to be cleared for surgery pretty quickly.  I ended up having the surgery September 8, 2008.  The delay was due to scheduling constraints on my part.  Having the surgery has been the best thing I could have ever done for myself.Please do not be discouraged if/ when your medical group denies your surgery.  If it's a covered benefit, you need to dig your heels in and appeal, appeal, appeal.