What happens next????

[samnic 0]

Hey Bandsters,

Can anyone tell me what your process was following your intial consultation for the lap band? How soon did you hear anything from the insurance? I am getting so many different stories from my doctors office and I am confused. When I talked to one person they told me I need to perform all my medical clearances before they submit anything to the insurance company, which in one way makes no sense, then they told me go ahead and start a 6 mo supervised diet because usually coventry insurance requires this, but no one has called my insurance company directly to find out anything so how are they even sure that my insurance will even cover this procedure before I do all of this???? Please help!!!!!!!!!!!!!!!

[nancypan 0]

Hey Bandsters,

Can anyone tell me what your process was following your intial consultation for the lap band? How soon did you hear anything from the insurance? I am getting so many different stories from my doctors office and I am confused. When I talked to one person they told me I need to perform all my medical clearances before they submit anything to the insurance company, which in one way makes no sense, then they told me go ahead and start a 6 mo supervised diet because usually coventry insurance requires this, but no one has called my insurance company directly to find out anything so how are they even sure that my insurance will even cover this procedure before I do all of this???? Please help!!!!!!!!!!!!!!!

Well - I would absolutely call my insurance company to find out if it was covered first of all. My insurance did cover it but I had to go through a 6 month supervised weight loss diet with my primary physician and then once that was completed I was sent for blood work, barium swallow, chest xray and psycological evaluation. Once I completed those I was scheduled for surgery within the next week. Once you start the process it goes by very fast. I was banded November 30th and things have been very smooth for me so far. I have not lost the weight I was expecting to as fast but I have not gotten to that sweet spot everyone talks about yet. I had my third fill today so I am hoping this takes me to that point!!.

[samnic 0]

Thanks I have called my insurance and they said it is covered but they didn't say anything about a supervised weight loss diet plan prior to sx. So I don't know what I need to do.

[carol285 145]

Every insurance has different requirements. I would call your back and specifically ask about a physician supervised diet. For instance my insurance requires a 6 month supervised but they are flexible with it. So after my initial consult I started seeing my primary physician monthly while completing all the specialists I needed clearance from, Psychologist/Nutritionist/Cardiologist/Pulmonologist/Endocrinologist. When I received clearance from all of them & a letter fro my priary (even though I had only completed 3 months supervised diet) my 2nd consult appt was set to go over everything. At this 2nd consult we selected a surgery date!! For me it was 5 months & 1 day from 1st consult to surgery, but I had an almost 5 week delay for my 2nd consult due to a family emergency.

[HeatherinCA 10]

I think insurance or payment is step 1 after your surgeon approves you.. they wanna make sure you would be covered. Then the surgeon calls or writes for approval, this didn't take long for me, a day or two. Then after I scheduled the surgery I did all the tests and evaluations.

[vickyd 24]

My insurance company required a psych veal, proof that I had been obese for at least 5 years, and approval from my PCP. Once I had all of that info, it was submitted to my insurance for approval. Once approved, they scheduled the surgery and I had the testing done.

Each insurance has their own requirements but your surgeons office should have an insurance coordinator who will check the requirements and work with you to meet them (at least that was my experience).

[samnic 0]

ThAnks a lot. Thankfully I spoke to a wonderful rep at my insurance co today and she gave some great input. At least I know for sure that my plan Includes bariatric sx. I just have to go to certain doctors in the network. One step closer.

[ElizabethNYC 1]

First thing I would do is call your insurance company and ask them all about it. I got a list from my surgeon of all the stuff I had to do. Maybe ask them if they have something like that?!?! Hope everything works out.

[Rainydayz 3]

Congratulations on getting the ball rolling. My surgeon's office has a coordinator that keeps up with everything I need to do. They gave me a checklist of all the tests etc. I need and we are checking them off as I go. Psych. eval is next week, sleep study is to be scheduled... etc. They are double-checking my insurance requirements for the supervised diet but in the meantime I saw the nutritionist for the 1st appt. so if I do have to do 6 months I am not wasting my time. Once I have all the tests done they will submit it then and then we will schedule a date. They told me the clearance takes from between a couple of days to a few weeks depending on how busy the insurance people are.

Good luck!

[samnic 0]

Thanks for the great feedback. This is a great community here on lapband .com. I wish I had known about this sooner!!!!

Congratulations on getting the ball rolling. My surgeon's office has a coordinator that keeps up with everything I need to do. They gave me a checklist of all the tests etc. I need and we are checking them off as I go. Psych. eval is next week, sleep study is to be scheduled... etc. They are double-checking my insurance requirements for the supervised diet but in the meantime I saw the nutritionist for the 1st appt. so if I do have to do 6 months I am not wasting my time. Once I have all the tests done they will submit it then and then we will schedule a date. They told me the clearance takes from between a couple of days to a few weeks depending on how busy the insurance people are.

Good luck!