banded, then insurance changed to kaiser

[Becbec 0]

does anyone have any info.... i was banded. now have kaiser which does not cover band. they will refer if you have medicade or something like that. i really need a unfill. about 1x every6-8wks. i get food stuck and cant eat or drink or swallow my saliva for 2-3 days. kaiser bariatric dept office told me they will not refer, but they will remove the band completly. =-( thats so not what i want or need. i called other places for cash pricing.....they said they have kaiser patients and think it is weird the surgeons wont refer me. i heard maybe if i was seen by GI. then GI can refer me. any insight? thoughts? facts!

thanks.

sx oct 2011 279lbs.

today 225lbs.

i had lots of complications along the way.

lots of reflux, food stuck. i cant seem to eat greens without them getting stuck and blocking.

its horrible when i am so weak and cant function good from poor nutrition and no or little Water intake for several days. finally when the swelling from reflux & throwing up goes down, then i slowly tolerate warm broth. and work my way back from there. i cant live like that thought.

thanks again.

[clw126 15]

does anyone have any info.... i was banded. now have kaiser which does not cover band. they will refer if you have medicade or something like that. i really need a unfill. about 1x every6-8wks. i get food stuck and cant eat or drink or swallow my saliva for 2-3 days. kaiser bariatric dept office told me they will not refer' date=' but they will remove the band completly. =-( thats so not what i want or need. i called other places for cash pricing.....they said they have kaiser patients and think it is weird the surgeons wont refer me. i heard maybe if i was seen by GI. then GI can refer me. any insight? thoughts? facts!

thanks.

sx oct 2011 279lbs.

today 225lbs.

i had lots of complications along the way.

lots of reflux, food stuck. i cant seem to eat greens without them getting stuck and blocking.

its horrible when i am so weak and cant function good from poor nutrition and no or little Water intake for several days. finally when the swelling from reflux & throwing up goes down, then i slowly tolerate warm broth. and work my way back from there. i cant live like that thought.

thanks again.[/quote']

I also just got insurance that doesn't cover the band. I have an appointment Friday. I was just gonna wait and see how much they charge me. I was thinking that the insurance would still pay for the visit, just not the adjustment.

Can you explain a little more what you mean by "refer" you?

[DELETE THIS ACCOUNT! 12,703]

This is just my opinion, but if it were me I'd just go to the ER where you know there is a bariatric surgeon on staff. Then, they have to give you an unfill. You can deal with the costs and insurance later.

A band too tight is extremely dangerous and it's imperative you get it resolved ASAP.

Best wishes.

[dylanmiles23 2,198]

Call the insurance company and tell them your situation and ask what do you suggest I do. Put the ball in their court (for a change).

Good luck with everything.

[lisacaron 5,075]

Mis has good advice!

If you are looking for a doctor to take care of your band issues going further after you have resolved the too tight band you have now, perhaps the doctor that you see in the ER will take on your case if he/she is a Bariatric doctor. If not ask them to give you a referral if that is what your insurance company requires for you to see another Bariatric doctor which you can probably find using the search feature on this site for one close to you.

Good luck and please take care!

[Becbec 0]

to clw: when i say refer, i mean with lots of insurances (kaiser is mine) your primary doctor has to refer you to see any specialist before you can see them. since kaiser doesnt do lapband in oregon, the kaiser bariatric surgeons would have to refer me to another hospital with lapband sx. i tried that...i & my primary doctor were told no. they cant refer for lapband. however member services said if i see a gastrointerologist, and they could refer me. i think its weird that 1 specialist has the power to refer, but not the other. well..........i pray that the GI doctor is allowed to refer me so i can begin the probably long process of denial & appeal. not sure if thats how it works, or if GI deams it medically necessary that i automatically get approved to another hospital?

[Becbec 0]

the er has been a thought for final last resort. if it ever last longer than 3 days i will defenitly go in! it would be where i got the band. i can pay cash for unfill it is about $400 total. i priced 5 different hospitals locally.

I did speak with the insurance & told them to give me options. they said they would send a list of outside recommended MD, or i can get surgery to remove band. why would they want to spend that much $$ for sx. instead of a smaller amount for an unfill/fill. crazy people. so if i had $$$ any MD would help me.

[Becbec 0]

oh and basically there are no doctors in the ED that would be able to unfill in and emergency. they would have to call in the doctor that is oncall that has privillages w/ their ED. so i would get a huge emergency bill & then a huge bill from the specialty lapband MD. i am a single mom & cant afford that, yet make "too much" to qualify for financial help. =-( but if it gets that bad, of course i will be in the ED.

[lisacaron 5,075]

Bec I wish you the best! It sounds like this insurance company you have is ridiculous.

Why would they pay for surgery and not your emergency bill?!

Perhaps you can do a little research on them, and see if there is a way around it. Or even if another Primary Care Doctor can give you the referral.

At least the GI doctor is a place to start. Good luck and keep us informed.

Also since you are in the USA, I think under Obama care you are supposed to be covered for treatment of any pre-existing conditions with a new insurance company, that might be an avenue worth exploring as well.

[Becbec 0]

lisa, awesome thought on obamacare! if all else i may have to wait till jan. when its in full effect. i have kaiser permanente it is a huge health care company all over the country. they provide and cover bariatric sx. just not the lapband. however they did say maybe in jan. if they found a doctor they would be covering it. but maybe they will be covering it due to health reform & thats why they looking for a doctor & change the insurance benifits coverage. i will keep u informed.