Little Nervous About Lap Band Insurance - Medicaid In Connecticut

[Violet953 46]

Hello everyone,

Little about me, my name is Stephanie and I've been in the process of having the lap band for over a year now. I have state insurance/medicaid and live in Connecticut. I'm having the surgery at Backus Hospital in Norwich with Dr. Tousignant, who I really love, he's super nice and so is all of the staff.

I have done everything for the insurance, 6 months+ worth of doctors visits monthly, which was covered through my medicaid but the Dietitian was not, and my surgeon said it was mandatory that I see her so I had to pay out of pocket for those visits, which was really hard but I got it done. Tomorrow is the last time I see her pre op, which will be a cooking demonstration.

I have been exercising every day for the past 3 months doing Walk Away The Pounds DVDs with Leslie Sansone (walking in place videos) which I love and have been doing the required diet, and so far lost 20 pounds. I've been doing anywhere between 2-3-4- and 5 miles every day. I feel great, and I have more energy already. I am so ready for the surgery, in fact I can't even wait to start my pre op diet!

Now, after all of this, my doctor submitted the paperwork to my insurance, and we are waiting on a decision. That was done I believe before Thanksgiving.

Haven't heard anything yet, and I just checked earlier today.

And then I got a letter in the mail. From my insurance basically saying that I no longer have my insurance anymore on the 11th of December. After absolutely freaking out and being terrified that I did all of this for nothing, and making all kinds of phone calls to find out what to do next, I think I've figured it all out.

They are saying that I make too much money now (even though my income hasn't changed in months) so I have to go on a spend down now. I have to give them $1,750.00 worth of medical bills and then my insurance will be reinstated for the next 6 months.

The hospitals billing department told me that I could have the surgery, and the bill would be submitted to the insurance. Then $1,750.00 I will owe, but the rest will be covered by my insurance, and I will have it again. They also told me that the hospital would cover 100% of the bill that I will owe. Which was great to hear because I told them I would pay payments but it would be hard for me.

So I told all of this to my surgeons people and they seemed to think everything was all set too. So that was a BIG relief let me tell you! But now I'm still kind of thinking this is too good to be true. Have any of you had trouble with medicaid giving you an answer, or had a spend down to deal with? I'm just nervous that maybe they won't give me an answer before the 11th, and then what, if I don't have insurance at all after that will I be screwed as far as getting an answer still? This has been so confusing and I just wish they'd give me an answer right away, then all would be fine.

I have been working out more and more to ease this stress. I still have my insurance until the 11th so I am having my pre op physical and obgyn exam before that date. The doc even told me that he was aiming towards giving me the surgery in the middle of December. What do you guys think???

[luckyfive101 6]

With or without insurance, the band is the best thing I have ever done for myself! I am self pay and only regret I have is not having done it sooner! As always, it is a personal decision and you need to weigh the risks/benefits and do what is right for you! Good luck and God Bless!

[kewlshort1 4]

First, I would move hell and high waters to get the surgery. That being said, I have worked in patient accounts for a number of years. I wouldn't count on the hospital covering your balance, and would think about alternatives. Even if the alternative is working like crazy to make payments. While hospitals are required to "write off" a certain amount of debt, and you may qualify based on income alone, every hospital I've worked at has the clause that states the assistance is NOT allowed for elective procedures. And as much as many of us would say this surgery is NEEDED and not just elective, it is going to be considered elective. Regardless of what the representative might have told you, the ultimate decision is way out of their hands. Perhaps you could contact patient accounts and get information on their assistance program. The guidelines should be clearly stated. Not trying to be a downer, just don't want you to wind up with added stress later!!

[Violet953 46]

Hey,

I appreciate any advice anyone gives me. Are you from CT tho? Cuz I'm just thinking the rules are probably different from state to state about that...but I am not worried about the bill, even if the $1,750.00 is not covered by the hospital after all, they told me I could make payments so that won't be a problem, as long as I don't have to pay it all at once, which they told me I won't have to.

The only thing I am worried about is the answer from the insurance for the surgery, if they don't give it to me before the 11th I'm not sure what I will do...because if they don't give me initial approval, and then the doc goes ahead with the surgery, bills my insurance, will they not cover it because they hadn't approved it beforehand? Its soo confusing!

So, we will see what happens, because like you said, I would do anything as well to get this done and I have, I've gone this far, and have been waiting for over a year! I will do whatever else needs to be done!

[DaWnGo 0]

I've worked in a medical office in CT and in general if they do not approve a procedure and you get it anyways it probably won't be covered. But if the office scheduled a date that would most likely lead me to believe they did their part to get your pre-approval and if it's approved you should know soon. Good luck with everything! I hope it all works out.

[Violet953 46]

Thanks

So she checked my status today and instead of an approval they sent a message saying that I need to see a cardiologist before they approve me. Now, I have an EKG scheduled tomorrow morning but apparently that won't cut it, I need to be evaluated by a cardiologist before they say yes to the surgery.

WHYYYYYYYYY DIDN'T THEY HAVE ME DO THIS MONTHS AGO? I just don't understand why they would send all the paperwork in, before having everything they needed for approval! It makes no sense. I thought I had everything done because my surgeon said so, and that he was going to go ahead with all of the paperwork.

After I found that out I was like okay this appointment needs to happen before the 11th so I called one in my area who had nothing until NEXT YEAR! So at that point I felt hopeless, but she called the one in Norwich for me which is a little bit of a drive but well worth it, for Friday the 2nd! So at least I will get that out of the way and they know to send the paperwork back right away afterwards.

Hopefully after that I will get my approval and then I can get my date!