What to ask my PC ????

[goldthimble 0]

Hi,

I am new to the board. I have been lurking for a few weeks. Asked some ins. questions and got great answers from someone on the boards. I have been to one informational meeting and will be going to my second next week. I also will see my PC on Tuesday and wondered what I should say to him and what I need from him to take to the surgeon for approval. Like many I have done diets, WW I reached goal 23 yrs ago , Jenny Craig reached goal 8 yrs ago, Medifast reached goal 3 yrs ago, not to mention SB, and nutrisystem (2 yrs ago & lost 2lbs in 6 wks). This last time I gained back so much I don't want to leave the house. I also have 5 sisters and two have had gastric bypass (over 300 lbs) And two sisters over 300 who are not in any hurry to take care of themselves. My BMI is 36 and I have several co- mobidities. Any help anyone can give me will be greatly appreciated. I have done much research and am ready to get on with my life. Oh I also have a wonderful husband of 35 yrs who loves me enough to support my decision and still likes to chase me around. I just can't move as fast.

Thanks and God Luck to all. :help:

[TerriDoodle 6]

Hi Thimble,

I am self-pay so I can't really help you with your insurance issues, but I can tell you that I found my surgeon to be very dedicated to helping people with the DISEASE of obesity. You clearly meet the criteria for the gaining/losing/gaining/losing syndrome along with co-morbidities. I can't imagine why you wouldn't be referred for surgery...unless your insurance company has some very stringent requirements. Seems to me like they'd rather pay for surgery than for a lifetime of other health issues that are surely coming down the pike.

Best of luck to you!!....and welcome!

[clb 0]

Hi and welcome- I am a newbie as well (banded 1-28-07) I was self-pay but did the first steps of Insurance. Does your surgeon offer a "package" of info for your PC? Mine does. But what you should start with is a 'heart-to-heart' with your PC...what you have tried, your co-morbidities, your BMI etc. S/he may well know about lapband. When I first broached the subject with mine, he had several other patients whom he had referred and was very happy with their success.

Good luck!

CLB

[faithmd 14]

Goldthimble,

The best thing you can do is call your insurance company and ask for their requirements for WLS. At the info session you attended you should have gotten a packet of informationa and usually it includes the "codes" for the surgery and the fills. You need to call your insurance comapny and make sure they cover these "codes." If you didn't get this info, the surgical center I attended the seesion at gave me these:

Laparoscopic surgical adjustable band: Procedure code 43770, diagnosis code 278.01

Most insurance companies have complex case managers who deal specifically with things like bariatric surgery. When you call you ins co, ask who handles bariatrics and also ask to be mailed the specific statement of benefits that either covers or denies the band along with the requirements. That way you have it in writing. Talk to the case manager, ask what you need to do. My case manager is great, she talked to me at length and gave me tips on what documentation she's seen get approved and what I would definitely be denied for. For example my company will not allow MD letters to say what I've done about losing weight, my documentation must be in the form of office notes from my MD.

Good luck!

[goldthimble 0]

Thank You, Thank You, Thank You for all the feed back. I am anxious to talk with my PC. Good Luck to all of you

Goldthimble