So Confused About This Whole Lap Band "insurance" Process...

[Coalminerswife23 2]

Hey everyone!!! I am so confused! I keep reading all of these forums on lapband and the insurance process and now I am starting to get concerned. I have Highmark BCBS out of Pennsylvania. I started my whole banding process on June 5th with my PCP supervised monthly visits. I did my seminar in late May in which I found out that indeed I was a candidate. So like I said, June 5th was my first PCP weigh-in. I had my monthly visits all the way up to Dec 5th. In September I met with my surgeon in which she game me a list of tests to have complete. I complete my bloodwork, sleep tests, Upper GI with Barium, and now I go Thursday for my Pysch and Nutritionist visit. (This was the earliest appt I could get)...

Now, here is where my confusion begins. Speaking with my Surgeon's assistant, she advised me that before she can submit me for approval after she rec'vs my Psych and Nutritionist Evaluations. I understand that as well...BUT She said that once she submits me, it will take 4-6 weeks for approval!!! So the tentatively schedule my surgery date for Feb 14th, 2012....Almost 2 months away.

June 5th - 242lbs

Dec 5th- 234lbs

Mild Obstructive sleep Apnea

High Cholestrol

Dystfunctional gallbladder- due to weight

Borderline Diabetic

Borderline HBP

Hopefully I don't get a denial...

So, how is everyone getting approvals in a matter of days when I am told it takes weeks?...I am so anxious to get this done and start the "New Me." Can anyone give me info on this?

[2bSMALLER 28]

When we submitted my paper work the first time , Aetna denied me after about the 3rd DAY. I had some missing paper work. We then had to appeal that. The lady who sets every thing up went out on sick leave so my paper work was set aside. Anyways , a few months went by before it was submitted again. The insurance companies have a certain amount of time to give a response . 4-6 weeks is what they are allowed . You may get an approval within a few days, few weeks or 4-6 weeks. We submitted my paper work the beginning of October , I was approved I think October 21st . Surgery was December 1.

[Coalminerswife23 2]

Thanks for the info...I am praying for a quick approval and a sooner surgery date. I guess I am so impatient because my Psych and Nutritionist appointment was supposed to be completed on October 31st, but I had to cancel it and reschedule. The soonest they could schedule me for was Dec 22nd (almost 2 months later)...I was hoping to be submitted early December now I am not going to be submitted til late this month or the first week of January... Thanks again for the info! Are you loving yotu band thus far?

[BayougirlMrsS 3,933]

Coal.... it is very important that you have the dr. office submit the dr. findings and all test results as a packet.... not individually..... insurance company will "loose" the paperwork are so they will say..... not as easy to lose a packet of paper than "one or two sheets". My dr. compiled all the paper work and gave them a surg. date... UHC approved on the first try.

Keep on top of the workers at your surg. office..... very important!!! I got my approval with in a week of the submission.

No sleep app, no HB, no Diebetes, no anything...... just FAT....5'2" and 223.... approved

Oh... and sorry about your lose last night against the 49er.... being a saints fan... i was cheering for you.

[Coalminerswife23 2]

LOL...Yeah my "Boys" were a little lagging last night. LOL...Thanks...I will make sure to stay on top of the surgeon's office. I saw your tracker...EXCELLENT!! Congrats! Hope that is me really soon! Again thanks for your great info. Merry Christmas luvbug!

[B-52 7,113]

I had the same insurance you have, Highmark of Pa. I say had, because it has now changed.

It was excellent! Paid for everything 100% Even paid for all my Dr. visits, pre-op testing, everything!

I wish I still had it.

With most Insurance companies it is not a question as to whether or not they will approve the surgery. It is more of a question as to whether or not they recognize it as a "Covered" procedure.

Like having your tonsils taken out, most if not all Insurances will recognize that as a "Covered" item. If they recognize it as a covered item, they will usually set a "Allowable" for that item.

It is up to your Dr.'s office to do a little magic to get it done within that allowable, or else you will have a co-pay.

One can find out right away if their insurance will cover the surgery.

If they cover the surgery, then you have to meet their criteria to be eligible. The girl in the office did a print out with a list of all the hoops they wanted me to jump through, starting with my weight and BMI. If that was in their range, then I left with the Quest to complete all the other tasks, within 6 months.

[Coalminerswife23 2]

@B-52....Thank you!!! That made me feel so much better. Before I started my journey, I called my Insurance to see if it was covered. I called in and they confirmed that the medical codes that i gave them were covered 100%. I have remained within my guidelines. The only thing that concerns me is that during my 6 months supervised, in my third month, I gained 3 pounds. I was dealing with the tragic murder of my brother and food became my comfort once again...But in turn, I regrouped and got back on track and lost my weight. So I don't know if that lil fluctuation in weight will cause them to decline me. I have heard horror stories...

I must admit, you are right, this is the best insurance out there...(In my opinion...) My husband is a coal-miner (hence my user name) and they seem to always carry great insurance. Again, THANK YOU for comforting my concern and congrats on your progress....I look forward to seeing great numbers for myself as well.