Newbie here - Saying Hi!

[SaucyBandster 23]

Hello!

I am 37 and have been researching the Lap-Band for over a year. I was a consultant however with no insurance so didn't want to self pay.

So I went to Weight Watchers and lost 40 pounds until my center moved far away and it has all krept back on. Fast forward to now and I have a new position and insurance with Independence Blue Cross. WLS and LapBand are covered if a provider recommends it and I am at the very beginning stages.

This Wed I have my orientation.

Then Nov 3rd I have my Dr's appt with Dr. Rehnke in St Petersburg & that week I am going to the seminar.

With that said, I have NO idea if insurance will take his word for it or if I have to start with a PCP to get started. Having no insurance for long, I have been going to Minute Clinics for common colds, etc over the past few yrs and haven't had any issues to go to a Dr so therefor I have no history established.

I don't have any health issues but my BMI is definitely high enough to be considered. Not sure if this comes into play that I DON'T have HBP, sleep Apnea, etc... I have been fortunate to not develop anything from my weight, YET.

So here I am, ready and hoping this will get approved.

I have no clue if the insurance plan wants a supervised diet. (Is Weight Watchers considered for this??) I ask because I was weighed weekly for almost a year.

Any input from others who are in this stafe will be appreciated! I have a million questions but wanted to introduce myself first. I am already obsessed with this site as there are so many inspiring stories!!!

[Miller.ted 3]

Hi Chill,

Your primary doctor will give the insurance a note if you ask stating you need the surgery for your health.

As far as insurance, you either have it covered or not. You will know when the Dr Office calls in the codes for the procedure. They might accept WW but will still put you on a restricted diet. Not sure how long but again if you gave the Office your insurace information, they will tell you at the oreintation if you are approved. Actually you can call your insurance company and give them the code. The code for Lapband is CPT 43770 Keep me posted and good luck

[SaucyBandster 23]

Hi Chill,

Your primary doctor will give the insurance a note if you ask stating you need the surgery for your health.

As far as insurance, you either have it covered or not. You will know when the Dr Office calls in the codes for the procedure. They might accept WW but will still put you on a restricted diet. Not sure how long but again if you gave the Office your insurace information, they will tell you at the oreintation if you are approved. Actually you can call your insurance company and give them the code. The code for Lapband is CPT 43770 Keep me posted and good luck

Thanks for the note! My insurance company tells me the Lap Band is covered if medically necessary. So not sure what medicall necessary really means to an insurance company.

Tomorrow morning is my orientation and I will bring all of my paperwork and insurance info. My Dr's appt is on Nov 2nd so I am crossing my fingers for the green light. I will definitely keep you posted and would love to hear how you are doing.

Nervous for this step but very excited! Thanks for the friend add as well

[JerseyGirl80 12]

"Medically necessary" is basically a co-morbidity. The insurance companies are looking for a medical REASON as to why you need WLS, morbid obesity or a high BMI are not always enough of a reason for them. Some examples of medically necessary diagnosis' or co-morbidities are sleep Apnea, PCOS, Diabetes, High Blood Pressure, and other cardiac or pulmonary conditions. They want proof that your weight is a threat to your health. Which is stupid because obviously weight is a threat to ones health! But if you do not have any other co-morbidities as of yet, they could deny you for this.

Do you know for certain that you do not have sleep apnea? I didn't think I did because I didn't have any of the common symptoms, but it turned out that I did have mild sleep apnea after taking a sleep study (which was a requirement for me). My family history of diabetes, high blood pressure and my PCOS and Sleep Apnea helped with my insurance approval. They also wanted PROOF that I had been overweight for at least 2 years, the only thing they recongnized as actual proof were my medical records from my OBGYN. My weight history from Weight Watchers meant nothing. Also, I didn't need to be referred from my PCP, I went straight to finding a surgeon and was still approved after my medical history was submitted to insurance.

To insurance companies if it's not on paper (medical records), it didn't happen or it just doesn't exist. So not really having much of a medical history might be a problem. I don't know what your insurance requires (they're all different) but be prepared for anything, things can get quite messy. But hopefully things will go smoothly for you. Good Luck!

[SaucyBandster 23]

"Medically necessary" is basically a co-morbidity. The insurance companies are looking for a medical REASON as to why you need WLS, morbid obesity or a high BMI are not always enough of a reason for them. Some examples of medically necessary diagnosis' or co-morbidities are sleep Apnea, PCOS, Diabetes, High Blood Pressure, and other cardiac or pulmonary conditions. They want proof that your weight is a threat to your health. Which is stupid because obviously weight is a threat to ones health! But if you do not have any other co-morbidities as of yet, they could deny you for this.

Do you know for certain that you do not have sleep apnea? I didn't think I did because I didn't have any of the common symptoms, but it turned out that I did have mild sleep apnea after taking a sleep study (which was a requirement for me). My family history of diabetes, high blood pressure and my PCOS and Sleep Apnea helped with my insurance approval. They also wanted PROOF that I had been overweight for at least 2 years, the only thing they recongnized as actual proof were my medical records from my OBGYN. My weight history from Weight Watchers meant nothing. Also, I didn't need to be referred from my PCP, I went straight to finding a surgeon and was still approved after my medical history was submitted to insurance.

To insurance companies if it's not on paper (medical records), it didn't happen or it just doesn't exist. So not really having much of a medical history might be a problem. I don't know what your insurance requires (they're all different) but be prepared for anything, things can get quite messy. But hopefully things will go smoothly for you. Good Luck!

Thanks for your note on this. Actually no I do not know for sure but I assume because I have never seemed to have issues. My family history includes major heart disease on both sides, lupus, HBP, Diabetes, etc so I am trying to prevent any of those.

I do however have more severe asthma when I am heavier. My back is always in pain and makes it tougher to exercise even tho I enjoy doing so. So I am hoping we can go that route with the high BMI.

I went today for the orientation and am totally ready after all the questions and answers and the help they gave me. I felt very comfortable with the staff and the relationship with the hospital which has an incredible amount of bariatric surgeries each year. So at least I am able to wrap my head around it more. Next up is the Dr's appt. On that date, I will find out what my insurance actually covers. Crossing my fingers!

[JerseyGirl80 12]

Thanks for your note on this. Actually no I do not know for sure but I assume because I have never seemed to have issues. My family history includes major heart disease on both sides, lupus, HBP, Diabetes, etc so I am trying to prevent any of those.

I do however have more severe asthma when I am heavier. My back is always in pain and makes it tougher to exercise even tho I enjoy doing so. So I am hoping we can go that route with the high BMI.

I went today for the orientation and am totally ready after all the questions and answers and the help they gave me. I felt very comfortable with the staff and the relationship with the hospital which has an incredible amount of bariatric surgeries each year. So at least I am able to wrap my head around it more. Next up is the Dr's appt. On that date, I will find out what my insurance actually covers. Crossing my fingers!

The few problems you have and your family history may be a big help. I'm glad you found a doctor and staff that you are comfortable with, that's very important. I love my doctors and their entire staff are wonderful.. One tip, your doctor can answer all your questions the best but the one thing our doctors can't answer (unless they are a patients themselves) is what it's like to have a band on a daily basis, what swallowing, getting stuck, feeling full ect really feel like with a band. My doctor talked to me about this, she actually asked me to please explain all of it to her in full detail, she admitted to me that she can get frustrated not being able to truely answer certain things because they just cannot be answered unless you've experienced it. So for every question you ask your doc, you ask us here on this site too, you'll be amazed with the things you will learn. Good luck with everything! I got my fingers crossed for you!

[SaucyBandster 23]

The few problems you have and your family history may be a big help. I'm glad you found a doctor and staff that you are comfortable with, that's very important. I love my doctors and their entire staff are wonderful.. One tip, your doctor can answer all your questions the best but the one thing our doctors can't answer (unless they are a patients themselves) is what it's like to have a band on a daily basis, what swallowing, getting stuck, feeling full ect really feel like with a band. My doctor talked to me about this, she actually asked me to please explain all of it to her in full detail, she admitted to me that she can get frustrated not being able to truely answer certain things because they just cannot be answered unless you've experienced it. So for every question you ask your doc, you ask us here on this site too, you'll be amazed with the things you will learn. Good luck with everything! I got my fingers crossed for you!

Funny you mentioned this! I haven't even met the Dr. yet. I meet him early November. Today was my orientation at the Dr's office which is at the medical building at the hospital that I will have the surgery (if approved).

So the lady I met today is the head of Bariatric education at the hospital and holds the orientations. Ironically she was banded 7 yrs ago and 146 pounds lighter. Also, her husband and son have also been banded. She provided a wealth of info.

With today and this site, it just has put me in a really good spot mentally. I am going to call the office tomorrow and see what my insurance requires.

I was told I may need a 3 month supervised diet. With the holidays and stress and hosting them, I am not ready for surgery until early next year anyway. This would be perfect timing as come January, my life will be slow. Perfect NYE resolution right?

Thanks so much for the thoughts and writing me. It helps me wrap my head around it all in a better space if that makes sense. It was like the lightbulb came on once I joined here.