Pre Lap Band tests

[Synthia 0]

Hello, Im just starting out on this venture. I would like to know what types of tests are needed in order to have this procedure done. Im going to pay cash for this procedure and was just denied from an AETNA PPO for my BMI being to high, the fact that Im a smoker and my bi-polar disorder. Can anyone help me on giving me an idea on what tests are involed and if possible, how much they cost?? Thank you.:tt1:

[LeighaMason 19]

I was self pay and my tests were included in my total price. I had an EKG, blood tests, pregnancy test but not too much else. ( I know you hear a lot about quitting smoking so I am not trying to lecture you on that but my Dr also insists that patients stop smoking for 2 weeks before the surgery and he gives a nicotine test before he starts the surgery as well) Good luck I hope everything goes well for you.

[Synthia 0]

Thanks so much! I was told by the center that my tests were not included in the final price. Thank you for your post and I will work on quitting smoking :tt1:

[LeighaMason 19]

I just thought of something your insurance might pay for the tests even if they don't cover the surgery. Plus be sure and submit the surgery to the insurance company for reimbursement, I did on a foot surgery and they paid even though it had been denied on a pre-certification. It will help even if they pay a part. Slim chance but worth it, I think.

[BetsyB 9]

Preop, I had pulmonary function tests, blood work, an ECG, and psych testing.

Now I'm going to say something you won't want to hear--please know it's out of concern and kindness.

If your BMI is high enough that your insurance wants you to lose weight prior to banding, do you think it would be in your best interest, safety-wise, to step back, work really hard with your doctor, and get your BMI down to the level they require before surgery? (This would give you time to quit smoking, too).

I know the wait is horrendous. And believe me, I know the impossibility of lasting weight loss without surgery--I know.

But insurance companies aren't just saying no to save money. (Well, they are--but their "no" is based on their knowledge of surgical outcomes. And when the "no" means, "no--the surgical risk is too high," it might be really good to do everything possible to minimize the risk.)

I wish you great success with whatever choice you make, and we'll all be supportive no matter what. But please, choose surgeons carefully. Make sure yours has lots of experience with patients with higher BMIs. And do everything you can to reduce all other surgical risks--because you want to come out of this healthier.

[AnneGG 0]

Hi Synthia,

Welcome to a very helpful board!

I haven't had surgery yet, but all my pre-op tests are complete. I had a cardiology consult, a stress EKG, a pulmonary consult with a breathing test, a sleep study, a colonoscopy, an endoscopy, an upper GI, a mammogram, an abdominal ultrasound, 2 nutritionist consults, 6 months of physician supervised diet, and a psychiatric consult. Oh, and two info sessions. My man is thorough! Thankfully, all of it was covered by my insurance.

I agree with Betsy, though, that it would make sense for you to work closely with your doctor in terms of what you might need to manage pre-surgery.

What I've found out from these forums is that the lap-band® takes a lot of work making it work, so I'm trying my level best to get myself in shape before surgery.

Hope this is helpful...

Edited March 27, 2010 by AnneGG

[Synthia 0]

I agree with both of you, I have tried everything, though. The insurance denied me coverage completely. I dont have insurance and I applied for one and thats where I was denied. Im going to be self-pay. Thank you for your answers

[BetsyB 9]

I totally understand. Truly. And the fact that you were denied coverage does put things into a new light.

Whatever you decide, this is a great place for support.

The preop tests were not extensive, but some were pretty expensive. That said, some doctors do include them in their costs--if you haven't already, it might be a good idea to attend a handful of doctors' informational seminars. There is so much variation among them---hopefully, you'll hit on someone you really click with and who will help make this possible for you.

[Manda87 3]

Are you sure that one of the reasons why you were denied was because you are bi-polar? I have major depression and I was approved. (At one time my therapist thought I was Bi-polar.)

[anglov 0]

My insurance denied me too. They have the exclusion even if it is medically necessary so I am paying cash.

The cash price for mine only covers hospital, surgeon, anesthesiologist and 6 months of post op visits and fills. My insurace has covered the office visit and surgeon's consult because they ran it through with a regular office visit diagnosis code. I only had to pay a specialist copay.

I have a 3k deductible but they ran testing through that and it was covered but because of my deductible I still have to pay some. I had an intake visit which included a physical, psych eval, nutritionist and education class. I was billed separately for psych and physical so that only cost the copayment. I also had labs that day that ran after insurance discount $200. I then had a PET scan, which is a chemically induced stress test. I was given medicine that caused my heart to simulate a stress test without me doing anything. The cardiologist monitors it. After the insurance discount I still owe $1400. I then went for chest xray, EKG and more labs.

I have one more pre-op lab and I get banded on May 12th. I am diabetic and have a blood clotting disorder so I have extra labs done.

Part of me feels that since I am paying it myself then it is more of an investment for me. I am only afraid of complications that I would have to pay out of pocket. My surgeon said if he goes in and sees a hernia they will repair those for free.