Not banded yet but researching... Help please!

[Lowpockets68 3]

Hi... I have been researching the Lap-Band®® system for several months now and am 99.9% sure that this is what I need to do. My insurance, Highmark BCBS, will cover this surgery provided that all of their guidelines are met. I understand that and I understand with all but one. I can't get ANY clarification from BCBS.

One of their requirements is 6 consecutive months of structured nutrition and exercise program.

I can't get them to clarify exactly what they are looking for. Do I need a nutritionist and a personal trainer? I'm not made of money. If I was I could self pay. I just don't understand. Can anyone help? My PCP says that until I can get that clarified she won't refer me to a Lap-Band®® program. SOOOOOO discouraged!:blushing:

Thanks sooo much for any imput!

[Ashlea82 0]

I was just approved for Lap Band surgery through Aetna and will be having my surgery in the next 30-45 days. They require a 6 month diet also. I went to the weight loss clinic where the Dr that is performing my surgery is located once a month,weighed in and spoke with their dietician. But I believe that most insurance companies will allow your PCP to monitor you (with monthly weigh ins at their office) for this 6 month diet. You may want to contact the surgeons office that you are interested in and see if they have a plan for this 6 month diet. It is a VERY common insurance requirement and they should be prepared for this. I hope this helps.

[happygirl65 5]

It is usually clinical documentation (so dr.'s notes from your medical file) showing that you have been in a specific program. If it wants a structured program it wants you to show that you had regular weigh ins etc

[Lowpockets68 3]

Thank you all so much for your help and encouragement! I thought I understood when I started this research that it would be an interesting journey... It just seems a shame that the insurance company can dictate how your doctor can treat you medical needs. Oh well... such is life.

Thanks again to all!!! Have a wonderful Thanksgiving!:thumbup:

[honk 780]

I dont' think you specifically need a personal trainer. When I went for my first consult with the surgeon (I have PPO so dont' need a referral to a specialist) I brought a print out of all my visits to the gym. I had been going to the gym every day for a year and they ran a report of every time I checked in at the front desk. Most gym's today are all computerized and you check in with a key card. So if you have'nt joined a gym I would do so now. Personally I prefer to swim (when I was a kid I hated lap swimming; but the private gym I attend uses wayyy less chlorine.) I have a Water proof MP3 player which makes swimming so much more enjoyable. Also many health insurance/and or employers offer discounts for gym memberships (my previous employer even had a very nice onsite gym that was $10 a month). Ask your insurand and your HR department if there are specific gyms at which you can get a good rate. FYI I think sign on gym fees are a rip off. In this economy I would negociate a deal where you don't pay one.

[Cangel76 1]

When you have an initial consult with the doctor they will work the details out with you and the office managers will know all the details of what your insurance covers and what they need for documentation. Good luck!

[hopefully soon 13]

I have Highmark BCBS insurance as well and the requirement is that you have monthly "check ups" with your PCP that include a weigh in, review of your diet, and review of your exercise. They have to record this for 6 months and you need to lose at least a small amount of weight during that 6 month period to show that you can "follow a program" which is what they want to see. In my area, I was able to attend a seminar at the Bariatric Clinic and they have an insurance specialist on site to assist with helping you meet the requirements. They also provided me with the monthly forms that the PCP completes. During this 6 months, you can proceed with the other requirements such as meeting with a nutritionist, having blood work and other lab tests done, and attending support groups (required by some surgeons). This way, surgery can occur soon after the 6 months and insurance approval. I am on my way and will hopefully have my surgery in March or April!!!! Good Luck and start with a surgeon's office in your area

[hdavis15 0]

My BCBS is refusing to cover my surgery. I have to somehow come up with $5900 of the $9900 to have the surgery. I am very discouraged. Anyone know a way to raise the money without getting medical loans? My husband and I dont qualify for medical loans. what do i do?!?!?!!

as far as your 6 month journey before surgery my friend just had to visit with a nutritionist and it was covered by insurance.

[loserbob 11]

I had Highmark Keystone plan when I started(affiliated with BCBS). I checked out a few hospitals and all had the 6 month programs which made it easy. All I had to do was go once a month to my hospital and have a class and get weighed in. They told me I had to show some loss if I could but the main things were my weight couldnt fluctuate from month to month and I couldnt gain from my origional begining weight. At about month 5 I saw a psych. and nutritionist. Then I set up my surgery date. The hospital did everything as far as dealing with the surgery coverage and approval. I never paid a dime for my appointments or surgery other than my $10.00 co-pay one time in the begining.

[dcowens 2]

You can do this! It takes time to figure everything out and straighten out the details but I have faith in you! I had this problem, too. I called my insurance and asked what I need to do for the lap band (what testing I needed for the insurance etc) They said that they could not release the information. My doctor called my insurance and I started contacting bariatric surgery centers on my own. My surgery center is called Bridges. They had all the info that I needed for my surgery. Maybe you can call around your area for bariatric surgery centers? They were the biggest help for me. You would of course have to ask if they take your insurace. =) Good Luck