Tufts Navigator ppo

timeforchange · December 30, 2006

Hello, Anyone know how hard/easy to deal with Tufts Navigator PPO insurance for getting the Lapband procedure? Thanks in advance!

SherryW · December 30, 2006

I had Tuft HMO when I started the process and my insurance plan then switched to Tufts Liberty before my surgery and they accepted all the previous work fine. I believe that as long as your employer (or employer of the subscriber) hasn't written in an exclusion for WLS that you'd be covered no problem.

timeforchange · December 31, 2006

Thanks Sherri, Thats encouraging news. I just started my journey to lapland. I went to a seminar at Beth Isreal hospital in Boston Ma on thursday night. Congrats on your weightloss, I saw your weight tracker....WOW! I hope to be were you are soon! Was the whole start up process a drag or did it go pretty smoothly? Do I need to have my primary care physician refer me for the surgery? I have an apointment with her on the 7th. Thanks so much for your reply, this site is really just the encouragment I was looking for. Nicole

SherryW · December 31, 2006

Hi Nicole,

Yes you'll need a referral...well I know I needed one anyway. Where are you traveling from? I have to say I've been very pleased with BIDMC. I miss some of the gals there that were there when I started this process but, I've found their replacements quite friendly as well.

The whole process went pretty quickly for me. I was actually able to complete all my visits during the first week. You have to have a psych eval, ultrasounds, bloodwork etc. I got that taken care of the first week because someone cancelled their ultrasound Anyway...I started the process the first week in Dec 2005 and my surgery was 2/13/06 so thats quick. I think right now it's taking a little longer because they have so many more patients but, I still think if everything goes well and you're approved you'd be done by April or so.

Thanks for the congrats....I LOVE MY BAND! Hope the process goes well for you too!

timeforchange · December 31, 2006

Hi Sherry,

I'll be traveling from Salem, NH. It will be a bit of a hike but the nice thing is that my husbands folks live right down the street from Beth Isreal. They are always willing to watch the kids. I'm not sure though, if I want to tell anyone about the surgery. At the seminar I spoke to Dr. Jones, he seemed very nice and totally trustworthy.

I am so excited about this, but I don't want to set myself up to be disapointed if it doesn't go through. Is it wrong that I already have visions of myself borrowing my sisters clothes?:nervous

Thanks so much for your help...you're awsome! Nicole

SherryW · January 1, 2007

Hey Nicole,

The only people that knew about my surgery were my husband, son, mother and one friend. The others just thought I was on a diet. As time as progressed and I'm doing well with the band I've told a few more people. I'm careful with who I've told only because I don't want to have to listen to "Can you eat that?, Should you eat that? I don't know how you do it!" stuff. It's totally up to you who you want to know and the reasons behind it. I've had people at work ask me about the liquid stage diet after my surgery and how they want to go on it after New Years. What they don't realize is my stomach was the size of a bathroom dixie cup so no I wasn't hungry but, if it were normal size I know I would be. They haven't had the surgery yet want a liquid diet? Hell I tell them go on Slim fast lol.

Dr. Jones has been very nice. Truly I talk to the staff more than I do him but, that's natural. Everyone there has been very helpful and supportive. The nurses on the Bariatic wing have been going to the support/informationsl meetings so they can help out patients more too so that's great. I know because they were there when I went to a support meeting.

Have you completed your survey for BIDMC and met with Dr. H yet? Just curious where you are in the process. Also...just so you now a BIDMC thread was created too so you can chat with me and the other gals in there too if you'd like. Do a search for BIDMC and you'll find it.

Best of luck and feel free to PM me with any questions if you'd like. Happy New Year!

timeforchange · January 1, 2007

Happy New year Sherry!

I agree with you about telling a hand full of people, the only problem is telling my mother. I know I really should because she is going to find out at some point and be really hurt that I didn't confide in her. I also have to remember that when I told her I was interested in going to a seminar, she said ..."Why did you have to tell me that?" My mother and I are best friends and I am a person who can not tell a fib to save my life. If I do tell my inlaws, it will be after the surgery.....I'm so afraid of everyone trying to talk me out of it!

I have just started on this journey. I went to the seminar last Thursday night. I have made an apt. with my doctor (on the 9th) for a visit and with lots of luck a referral to have this surgery. I haven't made the apt. with Dr. Jones yet because I want to know that I have the referral first. I'm just nervous that somthing will go wrong. I am a little under 5.4 feet and weigh 251lbs Ugh! I know I fit the qualifications with that. I don't have any health problems other than aches and pains and numbness in my arms from being overweight. I have been overweight for 28 years.....I am 33 years old.

I'm going to check out that BIDMC thread, that great! Thanks so much for taking the time and helping me. Your knowledge and experiance is very valuable to me! Your new friend, Nicole:tea:

SherryW · January 3, 2007

Hey Nicole,

I'm 5'4 and was 277 pounds. I had aches and pains as well and that definately counts towards the requirements for the surgery. I have to honestly say I don't regret this surgery not even a bit. Its the best decision I've made for myself in a long long time. I'm finally taking time for me. It is work....you can't expect the band to do it all but, you know that's what I like about it. I still have to make the choices it just helps keep me on track. Before...during the holidays I would of gained 10 pounds easy eating all the fudge, Cookies, cakes etc. This year I had some of those things but, I can't eat much of it because of the band plus....I've worked hard so far that I'm not willing to give it back hahaha. It's not always easy and I do go up a few pounds sometimes but, the band keeps me going in the right direction it won't let me give up. I do wish you the best in your journey and please feel free to PM me anytime with any questions you have. I too didn't meet with Dr. Jones or the Bariatric center until I had the referral. What I suggest is that you print out the information located on Beth Israels website for your doctor. Make sure to print out all the info about the surgery, results etc. My doc had no idea the about the surgery and spoke with surgeons at the hospital she is affiliated with. Those surgeons told her to refer me to BIDMC. If your doc knows you well and knows the struggles you've had she/he will help you with this. My doc asked me if I was sure this is what I wanted I told her I've been researching this for a long time, I know it's a tool not a miracle and that I have to work with it in order for it to work. I told her the Bariatric center will make me have a Psych eval, physical, ultrasounds etc to make sure this is for me. She was satisfied with that and gave me the referal. So prepare yourself, educate yourself with all the info and show the doc how excited you are about it. How can he/she say no after that? If he/She does then get another doctor Best of luck!

Sherry

wendyjoy · January 4, 2007

Hey Nicole,

I grew up in Salem NH and graduated from Salem High. I now live in Northern MA. I too have Tufts and I am currently going through the insurance process. I am going to Winchester Hospital if all goes well. Dr's office right across from Stone Zoo. Very convenient location and Dr is Very nice and has done many procedures. My paper work is being sent to insurance as we speak and I am waiting to hear. I called Tufts and they said that it goes to clinical review and then make their decision within 48 hrs. I don't know I will wait and see. Good luck maybe I will see you at the Rockingham Mall

Wendy

timeforchange · January 4, 2007

Sherry,

That is a great idea....I am going to write out a list of facts and also what bothers me physically about being overweight. I think this will work to my advantage because I often times turn into mush when in front of a Doctor. I am totally ready for this now, I have read about this surgery, I have watched the surgery performed by Dr. Vernon at B&W Hospital and I have now gone to a seminar and spoken with the surgeon. I am convinced and so excited to put this into action. I know it is going to be hard work but every time it gets tuff I'll look at my children and know that this is why I am doing this. I'll take you up on pming you....I'm sure I'll have lots of questions ahead of me. You are more than welcome to pm me any time too! I know you are further than I am in this Quest but its always nice to have another new friend to talk or vent to! Nicole

Wendy,

Thanks for responding. Did your Doctor send in the referral to tufts or did you go to the surgeons office first? I'm interested to hear how it all turns out, please keep us posted on any news! Best of luck! Oh, I'm always at Rockingham Mall!!! You can pm me any time too! :clap2: Nicole