spoiltmom

Well I just called my insurance company again. They officially received all my predetermination papers on 7/12. They now have until 8/11 to make a decision. I hope they approve me and I hope they do it before then.

Congratulations to you also!!

congratulations!!!

In your situation I can see why they are asking you to do this. Even if you are a cash pay patient it is the surgeon's responsibility to make sure that you are completely mentally ready to make the necessary changes.

Will that cause any problems? My first surgeon already submitted a predetermination and it's under review but I've found a much better surgeon that I'd rather use. Will this cause any problems or should I wait until the predetermination is approved or denied first? I'd like to see the new surgeon next Tuesday but my insurance make take 28 more days to make a decision. Thanks!

Here's a link to my previous post to give you the back story: http://www.lapbandtalk.com/f84/please-help-im-standstill-my-surgeons-office-117422/ ' Okay so after all that on June 30th the insurance lady told me she would get everything submitted that day to my insurance company. Now here it is July 12th and my insurance company hasn't received ANYTHING from her. Now if I call her back she's going to be agitated b/c she told me to stop calling my insurance company. I want this done so badly. This surgeon is the closest to me at only 30 miles from my house but I really want and need this. Should I quit playing games with this woman and see a different surgeon? That would mean me driving 80 to 150 miles one way but I'm wondering if this lady even knows how to do her job at this point. What would you do? I'm so frustrated:( Edited to ADD: There is a surgeon that takes my insurance that ONLY DOES weight loss surgery. They can see me on the 20th and the lady on the phone was very, very friendly and helpful but they are a 2 hour drive. The surgeon I'm trying to use locally is a general surgeon that also does Lap Band.

Good Luck to you!!

Congratulations!!!

Okay I called for an update and she said that she faxed the predetermination but she didn't get it done until July 8th b/c she was waiting on some of my med records. She said it was 40 pages total. She also said she's not sure they are going to approve me which I already knew b/c I'm borderline on their co morbiidities. I asked her what their cash price is and she said $12,500 and then all my fills will be covered by my insurance under my copay. I asked her why and she said b/c they only charge for an office visit and don't specify anything. That sort of sounds like insurance fraud doesn't it? But the problem is I have 3 kids at home ages 9, 3 and 3 months so If I use someone locally then I need a sitter for 2 hours for my follow ups. If I use someone out of town I need a sitter all day and I only have one sitter to choose from. Advice?

Oh and according to Allergan the out of town surgeon has performed at least 75 Lap Band surgeries last year. The local surgeon does not have that accreditation.

After you get the band does it help with the horrible hunger that comes with your period? I would assume it would help since your stomach will hold less. Just curious:) I've had my tubes tied and uterine ablation so I don't exactly get a period but I still get all the lovely PMS.

I'm just curious those of you that got your health insurance to cover your lap band did you get approved the first time or did you have to do appeals? Which insurance company do you have? thanks!

And of course the fact that it's completely reversible and non invasive!

When I started I was scared and nervous. I wondered if I was making the right decision and what my husband and family members would think. Now that I've really started researching and getting all the paperwork started I'm really not nervous anymore. I'm excited and I want the band now more than I ever have! I absolutely can't wait to get the surgery done. Now if my insurance would just hurry up and approve me.

I don't work but I am a stay at home mom to 3 kids ages 9, 3 and 3 months. My dh works 12 hours a day. I worry about having the energy to keep up with them while on the liquid diet.

I have United Health Care. My plan has very few requirements so that's a plus!

Yay!! Congratulations!!

I passed it with flying colors. The psych doctor said he will write me a great letter to send in to my insurance company. He definitely thinks that I'm a great candidate for Lap Band and he's happy that I've made the decision to get it:) I was also supposed to have my dietary consult but here's what happened: My surgeon only uses one specific hospital. That hospital called ME and scheduled the appointemnt. They called yesterday to remind me of the appointment then called again at 9:30 this morning to say that my insurance won't cover it. She said If I pay up front they would do it for $125. I said fine. She said okay your appointment is at 11 so be here by 10:30. I got there at 10:30 they filled out my papers and took my money then sent me to the lobby to wait. At 11:15..YES 45 minutes later....they informed me that they had made a mistake and there wasn't a dietician in the hospital today so I would have to reschedule. I was so mad. I thought it was very unprofessional of them to make me pay upfront and not even check to see if the lady was there first. I demanded a refund. I told them I would repay them when I actually get to see a dietician:( The psych doctor said the main point of the psych exam is just to weed out the Bi Polar patients. Depression is fine and anxiety is fine as long as you aren't Bi polar.

He said it was because when a Bi Polar goes Manic they usually get non compliant and eat things they shouldn't which in turn messes with the band.

Are his notes hand written or are they electronic? If they are electronic that happens all the time and he can easily go back and fix it.

As of today they still show that they haven't even received the info yet:( Once they get it she said they can take 30 days to decide.

You should definitely get another opinion. My friend's mom got the band at 400 pounds. She's now 160 and looks great.

I guess what's making me so nervous is I'm sort of borderline on their requirements. They require your BMI to be between 35-39 with 1 comorbidity. I have hypertension and sleep apnea but the catch is....they want the hypertension to be UNCONTROLLED and the apnea to be severe. My Hypertension is controlled with meds and my apnea is mild to moderate. SO I'm in a gray area I guess. Just hoping they take mercy on me.

I think that it would reduce your supply since you won't be able to eat as much. I may be wrong but if you want the band it might be best to wean him. I'd ask your pediatrician.

the insurance lady at my surgeon's office said I should know by the end of next week if my insurance will approve and pay for the Lap Band. Keep your fingers crossed for me please. I can't afford to pay cash for this at all and the insurance will pay for it 100% if they approve me.