uggg...

[Sbharris74 0]

Procedure now covered by insurance since July 1st. Was approved for surgery. Went to consultation. Dr. told me he knows it is approved, BUT...he had no idea what the criteria was to follow through with. SO, he made 2nd appointment so he could find out exactly what proverbial hoops i need to jump through. I had already waited a month to even see him! Jeez....is he incompetent or what? I was told by his nurse that i only have a six month window to have the surgery. Plus the coverage for only 6 appointments...1 per month...to still be qualified. Does this sound right? Am i wasting precious time???? Also, he is only surgeon in state. So i have to just wait it out....uggg.

[TBone55 5]

I don't think he is incompetent, as much as it's new to them. At first my insurance did require me to be monitored for 6 months by a physician for weight loss b/4 they would approve the surgery. My insurance was new to cover the band and some things weren't clear at first as to the what / whens, but I am glad I was patient and it all worked out. But I can advise you to stay on top of it, so you don't miss out on the opportunity to have the surgery. Good luck. Tammy

[GoingforGoal 1,734]

Hello,

By your own admission, your insurance just permitted coverage as of July of this year. Unfortunately, EVERY insur. co. has different requirements and those requirements need to be verified and met by the doctor's office. Typically when the docs office has been working w/ certain insur. companies they know by hard what they expect and can get the ball started much earlier.

I hope that he was able to get the first steps started (ie maybe an assessment etc). But be ready to get patient because your actual surgery may not be for months (some even have to undergo a 6 month medically monitored diet prior to surgery). If I were you, I'd look up the requirements so that you have a good idea what to expect and won't be too shocked at your next doc appt when he tells you what your steps will be.

Congrats on choosing the band...it will come SOON

[Bandista 7,466]

Hi there, congratulations on first two hurdles -- that your insurance now covers this and that you qualify. It sounds like the surgeon's office is double-checking with your insurance company on any requirements. You should call them, too! My insurance company has only a BMI requirement -- must be 40 or above. Many insurance companies allow for co-morbidities such as high BP or sleep apnea but mine appears to be firm on the BMI of 40. Some insurance companies require particular pre-op diets, etc. My guess is now that you've seen the surgeon the administrative staff will be right on it. They want to make sure you don't end up with any unanticipated expenses.

I feel frustrated by how long the process has been for me but I think in a way it's been good as I've learned so much more about post-band life by reading people's questions, answers, thoughts, etc. on this forum. I have a much better idea of what to expect -- and although I've been given info by my hospital it is nothing compared to the real world experiences of this sampling of people who have walked this road to wellness. Best wishes to you as you start this journey!

[lisacaron 5,075]

I agree with you Bandista 100%. Too many jump into surgery before they really know what to expect and even then, every ones experience is different.

My advice to Sbharris is to stay in close contact with your insurance carrier and your Dr. office. They are both on your pay roll so to speak, keep them accountable to each other and most of all to you.

Be the band leader for yourself!!

Best of luck on your journey.

[Sbharris74 0]

Thank you all for your valuable information!!! It has helped calm my nerves quite a bit!!! It all makes sense to me!!! I know now that I just need to keep up with everything and just bide my time. Again, Thank you SO much guys!!!!