xylena88 6 Posted January 7, 2013 Hi everyone! I am new here and am looking into getting the band. Quite honestly I am not so sure where start. So any help would be wonderful! I am 286 5'3" Been overweight/obese my whole life. I have tried WW on my own (I couldn't afford the classes at the time) and while I have no problem eating healthy it's just that I always felt so starved. I have also tried many different diets and going to the gym but I would just gain anything back that I lost. I really want to make the lifestyle changes but I would love to have this tool to help me along the way. I haven't seen a doctor or called my insurance. What should I do first? Do I just see my PCP? I have BCBS Montana insurance through Wells Fargo, does anyone have any experience with getting approved through them? I have lots a questions but these are just a few, thank you in advance to anyone that helps! Share this post Link to post Share on other sites
♥LovetheNewMe♥ 1,216 Posted January 7, 2013 I would start with your insurance provider to find out if the surgery is covered so you know if you are going to have to pay out of pocket. Than I would go see my PCP and have them refer you to a WLS that is in your network if covered by your insurance. If you log onto the original LAPBAND site you can request a packet of information and they will send you a very nice packet to explain the procedure and get you started on your way. It generally takes a few months to pull everything together and some it takes longer to meet their insurances requirements. Good luck to you. I do have BCBS but of SC not Montana and mine did cover the surgery with a 500 dollar out of pocket co-pay. I also had to show failure of dieting programs and had to have letters from my PCP to show that I had tried other means of losing weight and failed. Like you, I had done, WW, Jenny Craig, Curves, and multiple other means over the years and would lose only to gain back and gain more. I also had several comorbidites that helped my case, sleep apnea, asthma and hypertension along with mordid obesity. So tomorrow call your insurance and good luck. 2 kazjim98 and catfish87 reacted to this Share this post Link to post Share on other sites
Banjo257 920 Posted January 7, 2013 Bcbs took care of me. I hope they do the same for you! Good luck 1 kazjim98 reacted to this Share this post Link to post Share on other sites
kazjim98 618 Posted January 7, 2013 Great advice above!! My first move after checking to see that wls was covered by my insurance was to attend a free seminar which my surgeon did, at the weightloss surgery clinic... they then told me what my insurance required and what steps to make...Good Luck to you! Share this post Link to post Share on other sites
Instyle98 240 Posted January 7, 2013 I contacted 2 different places that contacted my insurance for me. I chose True Results and even though I was out of network, they charged me as if I were in network so I had to pay my co-pay on my visits and at the time of surgery I had to pay my remaining in network out of pocket which was $1200 plus some change. I haven't gotten the anesthesia bill yet so I don't know what that will be. Plus I had to pay $400 out of pocket for my sleep study that insurance didn't cover. Share this post Link to post Share on other sites
xylena88 6 Posted January 7, 2013 Thank you so much for your answers! Gives me a great place to start. I have a new question. Whats the most common process of getting an approval? Is it really hard? Share this post Link to post Share on other sites
♥LovetheNewMe♥ 1,216 Posted January 7, 2013 Thank you so much for your answers! Gives me a great place to start. I have a new question. Whats the most common process of getting an approval? Is it really hard? Most insurance companies if they cover require some documentation of failed weight loss. If you have never had discussed your weight with your physician and they have documented issues than you may have to do 6 months of a monitored diet. I was lucky, I went to a seminar in September and had surgery less than 30 days later. This is not the norm. Share this post Link to post Share on other sites
Instyle98 240 Posted January 7, 2013 Usually the specialty clinics will take care of getting approval. That's what their insurance departments are there for. They will get your history from you, have you sign consents for release of records from your doctors, etc. If you are denied, most will help you appeal. Share this post Link to post Share on other sites
xylena88 6 Posted January 7, 2013 Sorry for all the questions! I just get so nervous calling places...I have no clue why! But when I call to set up an appointment with my PCP and they ask why, What exactly do I tell them? It's seems like a silly question I just never know what the right thing to say is! Share this post Link to post Share on other sites
catfish87 3,471 Posted January 7, 2013 I agree with the above suggestions. Just set up an appointment with your PCP "to discuss weight loss surgery". And also contact your insurance provider to see if its a covered procedure. From there, I'd suggest going to a informational seminar in your area and meeting at least a couple different Dr's who do the different procedures. They may have persons there who have had the procedure done by them for you to talk to. (Keep in mind, they probably aren't gonna have folks there who didn't do well...so do more research on the DR., the procedure, etc. online if possible.) I'd suggest writing down questions you may have and keeping them in a little notebook or such, that way you'll know exactly what to ask. GOOD LUCK! Share this post Link to post Share on other sites
Djstola 26 Posted January 7, 2013 Sorry for all the questions! I just get so nervous calling places...I have no clue why! But when I call to set up an appointment with my PCP and they ask why' date=' What exactly do I tell them? It's seems like a silly question I just never know what the right thing to say is![/quote'] I have a hard time calling too. For me it's a combination of being totally embarrassed that I got this big combined with admitting I can't do this by myself. Not only is someone gonna change our insides physically, but we have to change mentally and emotionally. It took me two years to admit I have to have the Lap Band. I am in the very beginning stages too but am familiar with the process. I went through about two and a half years ago at John Hopkins but then lost too much weight on my 6 month diet. I got cocky and thought I could loose without the LapBand. I was wrong so this time I am ready And I tell PCP I want a blood pressure and weight check or you can tell them you might be getting surgery and you need to discuss it with the doctor. Share this post Link to post Share on other sites
MzKitty 5 Posted January 8, 2013 Don't be embarassed about asking questions! This is a really big decision and you need to take it step-by-step. I agree that contacting your insurance company is a great starting point, just so you know where you stand. I have BCBS in CT and they covered my banding. I also have several comorbidies such as sleep apnea, pre-diabetes, severe Migraines and the usual joint issues - all of which help in getting approved. Other than that, do your research. There are many places doing this procedure that aren't necessarily places you want to go. Try to get in with the best surgeons and the best program possible in your area. I just had my surgery on Jan. 2nd. , but have been in the process for 8 or 9 months. Not only insurance, but the surgeon wanted me to attend an initial information session, then meet with him, then have appointments with a cardiologist, nutritionist, psychologist, do a sleep study, attend support group meetings etc . . . They wanted to be extremely thorough in preparing me (and my family) for the transition). It may take a while, but the extra time is worth the peace-of-mind knowing that all your bases are covered and you have time to really absorb what you are going to do. I'm very much a newbie to being banded, but I do know that I could believe everything possible had been done to avoid complications and ensure success for the surgery and that was worth a lot to me and my family Good Luck!! Share this post Link to post Share on other sites
