My insurance covers it BUT ...

[SkinnyInside=) 5]

So my insurance DOES cover the Lap-Band surgery ! im so thrilled about that !! However, they wouldnt tell me all the requirements and records needed to get approved for it. She said it was up to my Dr to see what was needed ?? I dont understand that . So i made an appt with my new PCP this morning for Saturday and i have my very first appt with the surgeon on June 6th !! Im really hoping that he can provide everyhting that they will need because i dont have a history this past year. I was pregnant ! So the only thing anyone has on file is my Obgyn record of my weight durning that time. Do you think that would be enough ? I havent been to a regular PCP in a few years since moving to a different state . So im kindof worried about that : /

[vickyd 24]

I'm suprised your insurance company wouldn't tell you their requirements to get approved, but I can tell you that my surgeon's office has an Insurance Coordinator who met with me and went over all of the requirements to get approved by both my insurance and my surgeon. Every insurance is different but I had to have a psych evaluation, weight history for 5 years, referral from my PCP and then had to have an upper GI (barium swallow), EKG and Endoscopy (because they found some reflux doing the upper GI) and meet with their Nutritionist several times. The hardest part of it all was finding the 5 year weight history...I found that since I had moved to a new state (and changed doctors a couple of times) that my old doctors had purged my records. Luckily, I remembered that I had to have a breast biopsy 5 years ago and was able to contact the hospital and get my records from that in order to meet the requirements.

[LauraRN 2]

Some DR's offices don't require the 5 year weight records........Thank God.... Mine only asked for 2 years ....that was easier, but I have the 6 month nutrition classes one a month for 6 months........I really am just like "whatever". Hold on like a dog with a bone lol........ Whenever I hear they are trying to weed people out.........I get out my bone......laura

[SkinnyInside=) 5]

I'm suprised your insurance company wouldn't tell you their requirements to get approved, but I can tell you that my surgeon's office has an Insurance Coordinator who met with me and went over all of the requirements to get approved by both my insurance and my surgeon. Every insurance is different but I had to have a psych evaluation, weight history for 5 years, referral from my PCP and then had to have an upper GI (barium swallow), EKG and Endoscopy (because they found some reflux doing the upper GI) and meet with their Nutritionist several times. The hardest part of it all was finding the 5 year weight history...I found that since I had moved to a new state (and changed doctors a couple of times) that my old doctors had purged my records. Luckily, I remembered that I had to have a breast biopsy 5 years ago and was able to contact the hospital and get my records from that in order to meet the requirements.

Yes ! Im going to call my old Dr in Florida and PRAY he still has my records!

=)

[SkinnyInside=) 5]

Some DR's offices don't require the 5 year weight records........Thank God.... Mine only asked for 2 years ....that was easier, but I have the 6 month nutrition classes one a month for 6 months........I really am just like "whatever". Hold on like a dog with a bone lol........ Whenever I hear they are trying to weed people out.........I get out my bone......laura

HAHA~ Yea i hear ya !!! Hell ill wait 6 months ! Its better than a lifetime ! As long as i KNOW its going to happen , im cool . lol

[WEESIE 5]

I was able to get my insurance company to read me the exact requirements. I called many times through the approval process and the agents were varying degrees of cooperative. I would just keep calling until you find one who will read it to you. You are paying the premiums and it is YOUR policy. You have a right to the information. The information they gave me was actually less restrictive than what the clinic got. We submitted with what they told me and it went through. My holdup was also the five year history which the clinic believed I needed, but after being told by UHC that my policy did not require it we submitted with no documented history and it went through. I do have several co morbidities. Good luck to you.

[SkinnyInside=) 5]

I was able to get my insurance company to read me the exact requirements. I called many times through the approval process and the agents were varying degrees of cooperative. I would just keep calling until you find one who will read it to you. You are paying the premiums and it is YOUR policy.

Thank you so much ! I'm trying my best to get everything I could possiable need . I just really want this. I'm so ready for a life change. In fact it's already changing ! Thanks for the advice . I'm going up call them again until I get some answers

Congrats on the weight loss so far !!!!

[papoose 48]

I also check online. I have Aetna and they had all of their bariatric requirements online.

[Karon 1]

I'm suprised your insurance company wouldn't tell you their requirements to get approved, but I can tell you that my surgeon's office has an Insurance Coordinator who met with me and went over all of the requirements to get approved by both my insurance and my surgeon. Every insurance is different but I had to have a psych evaluation, weight history for 5 years, referral from my PCP and then had to have an upper GI (barium swallow), EKG and Endoscopy (because they found some reflux doing the upper GI) and meet with their Nutritionist several times. The hardest part of it all was finding the 5 year weight history...I found that since I had moved to a new state (and changed doctors a couple of times) that my old doctors had purged my records. Luckily, I remembered that I had to have a breast biopsy 5 years ago and was able to contact the hospital and get my records from that in order to meet the requirements.

Hi Vicki:

Can you speak more to the 5 years worth of dr. notes. That is where I am having a problem. I have been going to the doctor for years but for many of them I would refuse to be weighed. You ever heard of this before. When you said you got notes from the biopsy, how did that help and I suppose that was within the 5 year time-frame? What on there was helpful. were they looking specifically for your weight 5 years ago?

K

[vickyd 24]

Hi Vicki:

Can you speak more to the 5 years worth of dr. notes. That is where I am having a problem. I have been going to the doctor for years but for many of them I would refuse to be weighed. You ever heard of this before. When you said you got notes from the biopsy, how did that help and I suppose that was within the 5 year time-frame? What on there was helpful. were they looking specifically for your weight 5 years ago?

K

Sure. The 5 year requirement was from my insurance company. I had to provide proof that I had been obese for at least 5 years. Normally, it wouldn't have been an issue for me because I have to see my endocrinologist every 6 months to monitor my TSH levels (I had a thyroidectomy in 1999) but I ran into problems because many of my doctors had purged my records and as you know, many of us with weight issues avoid going to the doctor unless we absolutely have to because we don't want to get the lecture about our weight. In order to fulfill the requirement, I had to get creative and remembered that they recorded my weight before my biopsy which happened to be 5 years prior (I had to request it in writing and it took about a week to get the records). I didn't have records for each of the 5 years prior (couldn't get records from years 3 and 4) but it was obvious that I didn't lose 150 lbs and the regain it in 2 years.

If you have a requirement like that for your insurance company, it is possible that even though you refused to be weighed your doctor may have still noted that you were obese (I know my doctor checked that box on his form every time I went in). Also, if you did Weight Watchers or any other diet program it is possible that you can get those records...sometimes you just have to think outside the box...

[Karon 1]

Sure. The 5 year requirement was from my insurance company. I had to provide proof that I had been obese for at least 5 years. Normally, it wouldn't have been an issue for me because I have to see my endocrinologist every 6 months to monitor my TSH levels (I had a thyroidectomy in 1999) but I ran into problems because many of my doctors had purged my records and as you know, many of us with weight issues avoid going to the doctor unless we absolutely have to because we don't want to get the lecture about our weight. In order to fulfill the requirement, I had to get creative and remembered that they recorded my weight before my biopsy which happened to be 5 years prior (I had to request it in writing and it took about a week to get the records). I didn't have records for each of the 5 years prior (couldn't get records from years 3 and 4) but it was obvious that I didn't lose 150 lbs and the regain it in 2 years.

If you have a requirement like that for your insurance company, it is possible that even though you refused to be weighed your doctor may have still noted that you were obese (I know my doctor checked that box on his form every time I went in). Also, if you did Weight Watchers or any other diet program it is possible that you can get those records...sometimes you just have to think outside the box...

Thanks so much Vicki, that helps a lot. I may have some weight notes from knee replacement surgery, if it comes to that. Perhaps my surgeon recorded those notes then. Yes, we have to be creative, don't we???? Best wishes on continued success with your weight loss. Hope that mine will begin as planned on 7/12.

K

[vickyd 24]

Thanks so much Vicki, that helps a lot. I may have some weight notes from knee replacement surgery, if it comes to that. Perhaps my surgeon recorded those notes then. Yes, we have to be creative, don't we???? Best wishes on continued success with your weight loss. Hope that mine will begin as planned on 7/12.

K

I'll bet your surgeon does have those notes (I know mine had the notes from my knee surgery last year). Weight is normally part of your pre-op so they know how much medication/anesthesia to give during surgery.

Good luck to you, too! You've done so well before surgery, I'm sure you'll do great after surgery.

[SkinnyInside=) 5]

I'm suprised your insurance company wouldn't tell you their requirements to get approved, but I can tell you that my surgeon's office has an Insurance Coordinator who met with me and went over all of the requirements to get approved by both my insurance and my surgeon. Every insurance is different but I had to have a psych evaluation, weight history for 5 years, referral from my PCP and then had to have an upper GI (barium swallow), EKG and Endoscopy (because they found some reflux doing the upper GI) and meet with their Nutritionist several times. The hardest part of it all was finding the 5 year weight history...I found that since I had moved to a new state (and changed doctors a couple of times) that my old doctors had purged my records. Luckily, I remembered that I had to have a breast biopsy 5 years ago and was able to contact the hospital and get my records from that in order to meet the requirements.

So I called the surgeons office and she sent me 12 page questioner and a very long list of test i have to get done to get approved. it might take a while to get them all done but it-least the ball is rolling !! =)

[vickyd 24]

So I called the surgeons office and she sent me 12 page questioner and a very long list of test i have to get done to get approved. it might take a while to get them all done but it-least the ball is rolling !! =)

That's great! It's a bit of a process but looking back I'm glad it took several months because I used that time to work with my therapist to help get my head in the right place before having surgery. I think that has made such a difference for me!

Good luck!

[honk 780]

I had blue cross blue shield and the only requirement they really had was being over 40 BMI. Each doctor has their own requirements. Mine required EKG, up to date PAP and Mammogram, meetings with a Nutritionist, 3 mindful eating sessions with a psychologist, blood work. You will want to see what items your insurance covers (will depend on your policy) and then if you need to use someone in your network. I had really good insurance but did not cover nutritionist sessions for weight loss. They would have covered it if I was diabetic though. Shrug.