Just Starting The Process

[jt78423 0]

HELLO ALL!! My Name is Janet and I live in Commerce, TX. I am just starting the process. I found a doctor in Dallas that a friend of mine used for her banding last month. I called the docs office and got my information together as far as the steps I need to go through to get my insurance to pay. I have Aetna and apparently Aetna requires me to see a nutritionist, dietician and physician 1 a month for 3 months in a row and have everything documented. I have to wait at least until these appointment are done and documented before my surgeon will see me for my conultation and submit my information to Aetna for an approval. Does anybody out there know if Aetna normally approves this procuedure the 1st time submitted? I hate the waiting game!!

Janet

[sallyjo 0]

Welcome to the forum Janet. From Houston.I can't help you with your insurance questions. I have UHC and I went to the seminar and saw my surgeon the same day and 25 days later had my surgery. All I was required to have was a cardio release, but it is well worth the wait if that is what you have to do.I am six months out and only like 18 pounds until goal.

[Iluvharleys 15]

Welcome to LBT, and good luck!

[oldgiesser 0]

Hi Janet my name is Terry i am in the process of getting my Band . I started this in July 2006 When my wife and I attended the informational seminar that my Cardiologist recommended, it took till October to get my appointments for the Surgeons R.N., dietician and psychological evaluation. I have an appointment to see the Surgeon November 9th to go over every thing one on one. Then they will take all that paper work and summit it to the Insurance company for pre- authorization. When they receive it they will then give me the next Surgery appointment witch will be in late December or early January. The Surgenon doing the Lap Band is Walter Medlin M.D., F.A.C.S from Saint Marys Duluth Clinic in Duluth MN. They say that this is the normal time frame their no mater what . Some Insurance companies want you to also go though a supervised diet for 6 mths. first.Thankfully mine does not.The Bariatric team feels that if you have to go though all the hoops and time that you are sincere and not acting on a whim or fad. I cant wait to get the surgery:clap2: but am somewhat scared am new to this Forum also looks like a very helpful and supportive palace. Good luck with your journey and use the time to research and get prepared.

[jt78423 0]

Thanks for the support everyone!! I am very anxious to get my band and I am thankful there is a forum to go to for support.

God Bless You All~

Janet

[tonya66 13]

Hi Janet, I go to my first seminar on 11/11. I am hoping to have my surgery in January, but not sure how long it will take to get into seeing the doc after the seminar.

I called my insurance company and asked what qualifications are needed in order to get approved, (I have UHC) and they said a BMI of 40, thats it. So, I'm happy with that. They pay 90% and I'll be responsible for 10%, with a maximum out of pocket of $1000. I am waiting until January so I can put the funds in my payflex (an IRS provsion for medical expenses). I just hope I can have the surgery in January and not have to wait so long.

By this time next year, I want to say, I lost XXX amount of weight (hopefully at least 50lbs).

Well, Good-luck with your journey!

[jt78423 0]

Hi Tonya-

That is great that UHC only requires your BMI to be a 40. AETNA is killing me with all the hoops I am having to jump through. I am worried they will not approve me because my BMI is a 36, but I do have high blood pressure that has been documented by all of my doctors for the past 5 to 7 years. I am hoping and praying that I get the ok from Aetna the 1st time and that I do not have to appeal it. I really need this surgery!! I want to look good and feel good again!!

Best of luck to you~

Janet

237 lbs