Can anyone give me an idea...??

[tattooed 0]

of what happens between initial consultation with surgeon to actual surgery?

I'm not sure how this all works, for example...

I go for my consultation next month...is that when my paperwork is submitted to the insurance company? or do I have all of my testing done, then the paperwork is submitted?

when I go in for the consulation, what should I expect?

I'm so confused with all of this but I'm determined! :thumbup:

Thank you all for any info/help/insight!!!!!!!!!!!!! :thumbup:

[Melinco 1]

I can't help you regarding what they do for insurance purposes as I was self-pay. However, for me, after I had my initial consultation, I then scheduled my dietician consult and psychologist consult. My surgeon didn't require any other tests, but that was in part due to the fact that I didn't have any medical issues tha required it (such as sleep apnea).

After I finished the two consults, I went in for a pre-op appointment, where they took my official pre-op weight, started my pre-op diet that day, and then 10 days later had my surgery.

I found it to be a very smooth process and timely process. From the time I went to the seminar (which was in September), waited for my work schedule to clear (fall is a very busy season for us), had my intial consult at the beginning of November, then pre-op appointment on December 7, and surgery on December 17.

Now, from what I understand, insurance can throw a monkey wrench in the entire process, especially if they make you do a six month doctor supervised diet prior to submitting the paperwork. If so, then it won't be so short. If not, you could be in surgery before you know it and on your way to a slimmer new you!

Good luck with everything!

[patsal 1]

I went to my regular doctor in July. I told him I was tired of the rollar coaster ride with weight loss and regain and asked if he thought I might be a good candidate for a lap band.

Got referral from him.

Called Specialist--in my case the Dr. won't see you until you complete a test on the internet, get a psych eval, see the nutritionist, finally the Dr. will meet with you, then after the exam and a very long discussion surgery is scheduled.

My time frame looks like this

July PC

July call bariatric center

July take internet test

August psych eval

September nutitionist

November see surgeon

January Pre-op testing at hospital

Jan 26th pre-op testing

Jan 27th Regualr Dr. For clearance

Jan. 28th begin pre-op diet

February 12th surgery

Feb 23rd Post op appt.

I believe each dr. is different in their approach. I think that around here, this center is the busiest and they kind of make you jump through hoops to be sure you really are interested. There is another dr. in the area that requires different things. This was just the one I wanted to go to. For me insurance was not submitted to until after the meeting with the psych and nutritionist as well as the initial consult with the dr.

Edited January 19, 2010 by patsal

[NIGHTNANC 0]

Hello

i am now a friend. Don't think i ignored you, i don't get on that much anymore. I had a lap-band placed by dr schuricht at pa hospital last march. To date i have lost what you see below in 10 months. Not that it is easy but easier than doing it on my own without any tools. I like the band around my stomach. Let me see,

my initial consultation with dr schuricht was dec 4th 2008. That day is a meeting with the dr in a meeting room with other clients going to have surgery too. Dr s explains everything in detail to you over 3 hours. Also nutritionist and nurse practitioner there introducing themselves and answering all your questions. Then you will see the doctor privately in his office.he makes it a fun meeting.he is very nice man. After dr schuricht you will see the surgery scheduler and she gives you paperwork with everything you will need to know and when to do it, she tells you the insurance stuff.. My insurance(personal coice) said i had to see a nutritionist for 3 months(and try to lose weight,like i haven't tried this before lol) before i had surgery so dr schuricht's office set it all up for me and so my paperwork wasn't submitted to insurance till i was finished with those visits(i lost a pound). I had to set up appts with a psychiatrist, my primary (to write a letter stating why i needed this surgery),cardiologist,upper gi to see if everythg is normal, i already had a sleep dr so he had to write letter too sometimes you have to have sleep study.i had surgery march 23 2009. So in answer to your question it took me 14 weeks from my consultation to surgery day.

I will tell you it does seem overwhelming after you go home from the consultation but you are committed at this point and it works out.

Dr schuricht knows me as the open lap-band if you want to mention me. I started to bleed so he had to open me up but i was fine after(he also is very blunt so don't get your feelings hurt if he calls you fat etc). I was in recovery room after surgery and he comes in to see me and and tell me how surgery went, he said loudly that i had more belly fat then he thought that i had and it was more like "man fat". I just laugh at him.

Good luck!!! Let me know how you make out.

[tattooed 0]

Thank you to everyone who replied! And Thanks Nanc for accepting my friend request!!! :mad:

I've been reading about many the many different experiences that people have had when getting their Lap Band. I'm ready to do whatever needs to be done, but it just seemed soooooo confusing to me!

I'm glad to be somewhat straightened out and to have an idea of what to expect! Thanks again! :wink2:

[tattooed 0]

oh and another question regarding the 3 month/6 month supervised diet w/ the nutritionist....does it usually say in the policy that it is required? or is that something that they have to tell you??? ok that's prolly not the best way to phrase the question...

My insurance, Keystone Health Plan East, does not say anywhere under their bariatric surgery policy or on the policy given to my employer that this is required. it merely states the standard requirements to qualify for surgery...bmi of 40 or bmi of 35+ with a co-morbidity, must be medically necessary, etc etc...

just curious! thanks again everyone!

[PalmBayTish72 4]

Everyone's insurance plan is different, so I suggest you call your provider and ask them directly. In my circumstance, I have BCBS of Florida and although they do cover the lap Band procudeure, I do not know if they are going to require me to do the 6 months of supervised dr's weight loss prior to surgery.

I met with my surgeon on 1/13, with the psychiatrist yesterday and the nutritionist today. Once the psychiatrist and nutritionist submit their notes to my surgeon, they will submit everything to the insurance company. We don't know if they are going to require the 6 months, but we are submitting all my records from Weight Watchers, and supporting documents of my gym membership to hopefully circumvent that requirement. If the insurance company says the 6 months are required, I will just self pay. I've spent over 15 years of my life trying to lose and keep off weight, I'm NOT waiting another 6 months. Plus, spending my own money will keep me much more accountable! :mad:

I have a meeting with my surgeon on 2/24 so I should have my answer by then and will get my surgery date.

[caldwell33 0]

It's all up to your insurance company. Some will allow the surgery after 3 months from your initial visit others 6 months. Call your insurance company and make sure they cover the procedure ask them how long they require before surgery. Aetna is 3 months most of the others are 6 months. I was required to see a cardiologist, have and endoscopy done, see a phycologist, 3 visits with a nutritionist and have a apnea sleep study done and a chest xray. My surgery is scheduled for March 24th. My ins. co. ok'd for 3 months from initial consultation. Good Luck!

[mimi368 0]

Hi,

I met with my surgeon on 1/6/10 and I have to see the nutritionist, cardiologist, and psychiatrist over the next couple of weeks. I have already completed my 6 month physician supervised weight loss program. They told me that after all my appointments are finished they they will submit to my insurance. I have BCBS of Alabama. I think it depends on what your particular doctor's protocol is. Good luck!!!

[photo81 0]

I just went for my consultation on Monday and we just went over what test and paperwork I had and what I needed. So...I have to have a few more test and 1 more diet visit..so i say get all your stuff together then they can send it to the insurance then...just my opinion!

[montynic 1]

My timeline is as follows:

Jan 4 - informational session

Jan 18 - initial consultation

• this is where I was informed of the specific requirements of my insurance (such as nutrition consult and psych eval) as well as the specific pre-op tests required by my surgeon
  
• My insurance is Blue Shield of CA... the only requirements I could find regarding bariatric surgery were the minimum BMI of 35... apparently any other requirements are only known by the surgeon (which makes sense, considering they deal with our insurance companies far more than we do)
  
• I was informed that insurance authorization will not be requested until I have completed all my pre-op tests, as those reports are sent to the insurance company in support of the claim that the surgery is medically necessary
  

Today - mandatory Pre-op tests... EKG, chest x-ray, and labs

Jan 27 - nutrition consult

Feb 5 - psych eval

Tentative surgery date - 3/5

Hope this helps. Good luck on your journey!