nervous!!

Cinderella5596 · July 20, 2006

was anyone else really scared that they will not get approved by their insurance?? im waiting for my first appt. with the surgeon. im just really scared that this is the right thing to do but it wont work out for me. i know i might be freaking out prematurely but i have a gut feeling. i really think im going to get denied. i live in mass and have health new england. im going to pioneer valley surgeons. anyone want to share anything with me about insurance?? i can give you more background if youd like. if i get denied what can i do afterwords??

thanks!! Marissa :help:

Bettina · July 20, 2006

Marissa you are so not alone in this!!!

I am a nervous wreck over here. I have had all my tests, insurance paid for most of everything so far (with the exception of $30) I just found out I have sleep apnea so Tuesday I have to go get fitted for that lovely headress..lol. I won't know if insurane approves me -oh and by the way my husbands insurance does cover lap banding---I won't know until I am scheduled and the doc gives insurance the whole package to see if they will cover it. I am told that even though insurance covers it, they may not cover every single person for various reasons!! OMG shoot me now! This has been so crazy that I have only been able to eat one meal a day --not even snacks---and I have lost 6 lbs in the last week and a half! But if we do get denied, we can just appeal it to our insurance ( a friend of mine told me this) eventually they will get sick of hearing from you and hopefully cover the procedure. I have mentioned this on another thread and someone mentioned to me that if I look around I will notice that most people on LBT pay for their own procedure. I am in NJ and I have met many people that have banding or gastric bypass done (my sis is one) and none of them have had to pay out of pocket!!!! While I am crosssing my fingers for myself, I'll be crossing them for you too Marissa!!!!

Mvpo8961 · July 20, 2006

Marissa I don't know about your insurance in particular. But all insurances have policy/guidelines for approval or denial. I would think your surgeon's office manager would know more realistically how well approval/denials go for your insurance. The reason I say office manager as they are the one who submits paperwork for the surgeon to the insurance company.

If you should be denied you can go through an appeal process. The insurance company notifies you of the reason for denial. You can go from there to put together a packet to counter why you should not be denied.

It can be a lengthy process but it is definitely worth pursuing.

But don't put your cart before your horse. It will just stress you out.

Take things step by step.

Myra

Scribby · July 20, 2006

Trust me, I was denied three times and just got approved after a year..you have to be patient and fiesty. Dont give up if you are denied..its just a run around most of the time. I got denied for some stupid reasons more then once. Dont be afraid!

Scribby · July 20, 2006

Oh and btw, I was more scared of being denied then the actual surgery! I was like "sugery will be a breeze compare with the bs I have gone through with the insurance company!!"

RKidder · July 20, 2006

I, too. am waiting for insurance approval. I requested a copy of my insurance company's policy on weight loss surgery. I reviewed it, and my primary care physician and endocrinologist agreed with me that I met all of their criteria. Letters of medical necessity from my doctors were mailed out last week. I enclosed all information I gathered about the Bariatric Program at Portstmouth Regional Hospital, New Hampshire. So now I am playing the waiting game. Next week I am meeting with the Bariatric Coordinator, Nutritionist, Physical Therapist, and Psychologist - all on the same day, as I live 2 hours away. I will be staying the night before, as I plan to attend the Support Group that evening. I am determined, and I feel I have done my homework, so to speak. I found on the website that there are sample letters of appeal you can send to your insurance company. Be strong, be determined and don't give up. Best of luck to you sweetie. You will be in my thoughts and prayers.

Rachel

Mags · July 20, 2006

Dear Cinderella,

Boy, can I understand why you're nervous!!! What I would suggest is getting the requirements for lap band approval from your insurance company IN WRITING and bringing them to your doctor.

Also, find out what your company's policies are if you get turned down, but think positively!!

I'm in the middle of an appeal with my insurance company and I went to a pre-op lap band meeting at my surgeon's office the other day. I was surprised at how many people had no problems getting clearance.

Good luck!

Mags

wantlapband · July 20, 2006

I'm scared too...esp only having a bmi of 35.3, with some comorbities...I have BCBS New England..My date is scheduled for sept. 20th..I have a gut feeling myself and I hate it. I'm keeping my fingers crossed.

Let me know

Cinderella5596 · July 20, 2006

omg..you guys are amazing..im tearing up at how much support ive gotten...just people saying they will be thinking of me!! thanks tons!! i hope ill get this...my bmi is 45. going to a support meeting tonight. im going to try to ask some questions about insurance and peoples experiences. i know everyone is different but it is helping to hear how many people get approved...even after first being denied or being approved within no time. ill keep you all updated..thanks again, so much, really!!

Marissa

JMO · July 20, 2006

Hey nervous!,

Don't waist your nervous energy on this. You should be fine with a BMI of 45. You will prob. breeze through this and be like, "what was I nervous about?" good luck tonight and jkust take it all in...