Approval Process?

[DaddyMarie 291]

Ok so I am obviously new to all of this but I'm confused. My doctor is preparing to send my paperwork over to get my insurance to approve the surgery, (which he says should not be a problem at all) once that's approved I will meet with my surgeon. What happens next? Will he just schedule me a surgery date or will I need psych evaluations and classes? I know each doctor and insurance is different but what should I expect?

[Wendydarling19 310]

Everyone is different. Some ppl need to go to a ton of appts including sleep study, cardiologist, pulmonary specialist, pysch, nutrition for 6 months, and semenars. This however usually happens before submitting to insurance. I have the lowest requirements for my surgery because I work in the hospital where it is to be performed, so thats also where my insurance is from. I only have to get a letter of medical necessity, psych eval, and nutrition consult

[BlueMoon~T 276]

In my case, the patient advocate at the center where I had my surgery knew everything I needed in order to obtain approval. They set up all my appointments, then submitted my paperwork to insurance. After that, it was a week later I had my final consult with my surgeon where they scheduled my surgery for a week and a half later... Everyone's experience is different though!

Best Wishes!

[DaddyMarie 291]

This is becoming so real! My personal physician has been doing all the classes with me so he's the one submitting all my insurance paperwork for approval before I even meet with the surgeon. He wants to make sure I'm 100%covered so I don't acquire any in necessary costs before I go..

Thanks ladies for the insight!

[Bandista 7,466]

It sounds like you are in good hands with your PCP working with you ahead of time. The process at my hospital started with a mandatory information session followed by an appointment with the LB program coordinator. Then psych eval and meeting with a nutritionist (did these on the same day). This was followed by meeting the surgeon; got my surgery date at this time. One more meeting with nutritionist to get pre-op instructions, a couple of labs a week apart and then the actual surgery.

People have all sorts of different lead-ups to the surgery but that's how mine went. At times it felt so slow but looking back I think the wait time was good for me. I read through all the posts here to get an idea of what makes people successful. I also got a therapist to have a place to talk about the process and address eating issues -- really examined the ways I used food to anchor, reward, relieve stress, etc. And I started a journal to track all the appointments, the tidbits I picked up from this site, thoughts and fears, etc. I'm glad I have that one notebook. I take it with me to all my appointments. Main thing I did was step up my exercise. This really helped as post-surgery I was able to walk, walk, walk -- I am convinced that walking is a big part of my success so far.

Good luck to you! For me it's the best decision I've made in decades -- wish I had done it sooner. It is a gift to myself. I am choosing a happy healthy future.

[The Icy One 518]

I am always so interested in how different everyone's experience is. It sounds as if your doctor is very caring and involved in your care. That is so great. My doc is a sweetie and I can rely on her for great care but she is a little shy of the whole band thang. Well, she's going to have to get used it, now. Heh! Heh! Heh!

Every insurance company has different approval criteria. I went to a practice independent of my PCP, completely on my own, as my insurance doesn't require a referral or letter from my primary care doctor. I am going through True Results in Scottsdale, a self contained Lap Band centered WLS practice that handles the process start to finish.

My insurance required no seminar, I had to do four months of supervised visits of health/weight check visits where I was required to keep my weight within a five pound +/- range. It could not move from that range by even an ounce or I was out and would have had to start over. Less than two weeks before my last visit, my insurance changed the rules and said that my weight had to be at least one pound lower than my start weight at my last visit, so I had to crash diet like a madwoman for ten days to just squeak in under the acceptable maximum. It was a nail biter! I was required to meet with a nutritionist, an exercise physiologist and to have some simple medical tests. I was then subjected to a five week wait for my insurance to approve.

I received my approval by phone call from my practice and my approval letter a couple of days later from my insurance company, scheduled my surgery and started my pre op diet and I have my surgery tomorrow. (Yippee! finally! ) My surgery is being performed at an outpatient surgery center. I check in at the a*sscrack of way too frakking early in the morning, have my band installed, go home and recover in the comfort of my own home, with my loving hubby and son to pamper and wait on me hand and foot.

Good luck going forward. Enjoy this process. It's a huge thing, but it is also fascinating and there is a lot to learn. Dive in and get in to it. It's going to be a part of your life, from now on.

[DaddyMarie 291]

Interesting! We will see what happens