Insurance/hospital Lap Band Confusion (please Help. I'm Baffled.)

[Jeongbu 1]

Hi!

So, I have Tufts Health Plan and I'm in the six month iCanChangeProgram so that I can get my lapband surgery... but.

(I had my first call today, with my health coach.)

I'm confused as to... what the real steps are! I mean, I haven't scheduled a surgery or anything. I'm only nineteen years old and I don't know what the steps are, exactly. I only know about the program so that I can be covered. Do I have to schedule my own surgery? Or, does the insurance do it for me? Or, does my primary care doctor do it? I hope I don't seem too stupid. I'm just confused.

[Caribear 184]

That doesn't sound stupid to me - it's a legitimate question. Probably the best thing you can do is call your insurance company and ask, and see if they will send you some information about how it all works.

I don't have the same insurance as you, and I'm in the very early stages too, but so far as I can tell you have to complete all of your insurance co's requirements first, then your doctor (surgeon I think) will submit an approval request before they will schedule you. Personally, I have to complete 9 months of physician supervised diet, a psychological evaluation, and various other tests before I can even think about having an approval request submitted.

Maybe what you should do is make a list of questions, then call the insurance company and write everything down that they tell you. Don't be afraid to call them; it's their job to provide you with answers to your questions.

[MelindaH 3]

hon, the scheduling is done by the surgeons office. Insurance has to be approved before it can be scheduled. Also the surgeon may have some requirements of his own that may or may not correlate with the insurance' ones.

All the best to you.

Melinda

[SaucyBandster 23]

Have you been to a Lapband seminar yet? Typically there is a bariatric coordinator and it's their daily routine of working with insurance companies and knowing the in's and out's and pitfalls, etc... I would recommend attending one of if you already have a surgeon in mind, they usually have mandatory consults or seminars they hold which are very helpful. They definitely got the ball rolling for me. I am going on my 3rd (3 out of 3) supervised monthly weigh in's with my PCP and had my psyche eval last week. One more Dr's appt and I am then submitted to insurance. From there, once approved, the surgeons office will schedule my surgery date and guide me on my EKG, Chest X-Ray and Labwork appts.

Good Luck!