Anyone from Georgia ??

[candy8360 0]

I have BCBS PPO, my insurance covered everything so far, but I had to do certain things to be approved,

1. Have a three year weight history from Dr.

2. Give my own plan of what I have done to lose weight over the years

3. Have a recent physical including thryoid levels

4. Go through a psychological evaluation

5. Go to a nutrionist before hand, and Emory required me to go through a nutrional class. (the class I had to pay for out of pocket, $180)

Once I did these things they sent me up for pre approval. I was approved in about a week.

Then I had to have an endoscopy done.

[Artsy 0]

My father is paying for my surgery and has banned any out of the country options, but in the next breath says he doesn't want to pay too much for it...I'm stressing over trying to find a doctor.

Hi Ugagirl--I was an UGA girl myself. I'm in Georgia just south of Atlanta, and I actually decided to go to Dr. Kirshenbaum in Colorado. I had my surgery on 12/19. I think he's great--very nice and highly qualified. He charges less than 10K, so even with flights, it's still much less than around here.

Good luck!

[bensdad03 0]

Hi All!

I am from Griffin, GA, about 40 miles South of Atlanta. I have started the journey and hopefully will not have many more hurdles. I did get frustrated recently because I contacted my insurance (State of Georgia Health Plan with United Healthcare) months ago with the Lap Band surgery code and I was told that a letter of medical necessity would be required and a 30 day (max) review by a committee. So I went to the seminar, got the letter from my Primary Care Physician, received approval from my cardiologist, met with Dr. Scott Davis at Emory and just completed the Psych Eval last week. But when I contacted UHC again regarding the nutrition eval, the lady stated that the State of GA would not cover any weight loss surgery.... PERIOD.

The nutrition eval is my last step. I still have to write out my diet history over the last few years, but that will be fairly straight forward. I am going to go ahead and continue with the process to see what happens. I am praying that the first person I spoke with was right!! Once I am approved I will have to go to the $180 nutrition class previously mentioned, have the battery of tests and the EGD, then I will be scheduled for the surgery.

For any of you that stated that you had to self pay, were any of those UHC on the State of GA Health plan?

Also, does anyone that had the surgery with the Emory group know where to find a certified dietician or nutritionist that doesn't cost the $120.00 that the Emory folks do?

Look forward to chatting with you all - Happy New Year!

[4jin 0]

Hi there. I go to Dr. Johnson in Johns Creek, GA or Suwanee, GA. The nutritionist they recommended charges only $50. She has her own office at Dr. Johnson's office. Let me know if you want the telephone number.

[candy8360 0]

Bensdad, I went to a nutrionist that was in my book for BCBS, I only had to pay the $10 copay. I can find her name and number and you can contact her. I'm not sure what the charge would be if you went to her out of network. I did a quick search but couldn't find her. Can't remember her name. Will keep looking. If you have a network book, look and see if you have dietician's there.

By the way, Dr. Davis is great! I wish you luck. I remember reading something, I think it was on lapband.com about a group that helps you to file for an appeal with insurance if you are denied. I will look for that too.

[candy8360 0]

another note to bensdad:

I haven't had very much luck in locating the name of the nutrionist I used or in finding the information about filing an appeal.

I DID find this on 'bariatric edge' website. Might help some.

Appealing a Denial

If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state.

Work with Your Bariatric Program

Assistance is key. It is critical that you work with your bariatric program to determine the correct approach to appealing a denial. Your program is there to assist you and to help you adhere to your policy’s requirements.

Tip

Write a description of how morbid obesity decreases the quality of your life. Be sure to include details such as difficulty walking, socializing, or maintaining personal hygiene. This documentation can be useful for your bariatric program and health insurance company.

Possible Options After Appeals Even if you exhaust the appeals options, you still may have options:

- Independent review board: This is an option available to people in more than 40 states and doesn’t require a lawyer. Judgments usually are issued in 60 days. Check your state’s website for specific filing instructions. - Arbitration: Some health insurance companies require patients to use a third party—other than the patient’s lawyer and the insurance company—instead of going to court. - Litigation: This option is expensive and takes a lot of time.

[hopefulgirl 0]

Composite State Board of Medical Examiners: Search Licensee Database

The link above will give you some importanta information about whatever doctor you are considering using in any surgery. Just thought if would be helpful.

[ugagirl 0]

Hi Ugagirl--I was an UGA girl myself. I'm in Georgia just south of Atlanta, and I actually decided to go to Dr. Kirshenbaum in Colorado. I had my surgery on 12/19. I think he's great--very nice and highly qualified. He charges less than 10K, so even with flights, it's still much less than around here.

Good luck!:confused:

Hello! *waves*

I actually looked into that doctor in Colorado but he wants me to use someone within driving distance should something go wrong. I've got two consultations lined up with doctors in Alabama. My first is on Tuesday. :biggrin1:

They are doing an ultrasound of my liver and gallblader, a breathing test to see if I have some sort of bacteria (and if so-I will have to take meds to get that cleared up before they can do surgery), and a psych exam.

Would anyone be willing to share what their psych exams was like? Speaking of sharing...I emailed a few friends today to give them an update on my Tuesday appointment and I accidently included my immediate boss on the email. Needless to say I was mortified, especially as my wording appeared rather vague I'm sure b/c she had no idea I was looking into this and the update was literally "So, I have to have a psych exam on Tuesday."

Oops. :embarassed:

[candy8360 0]

my psych exam wasn't that bad. Just talked a lot about how I felt about having the surgery and why I wanted it. Talked about why I ate so much (mostly comfort foods). Talked about wanting to make positive changes and had to fill out a questionnaire that took FOREVER. Only two questions that I didn't completely tell the truth on. Even before I took the questionnaire the doc told me he was going to recommend me for the surgery.

[ugagirl 0]

Thanks for replying candy.

I figured it might be something like that.

[Stacy429 0]

I just found out my policy covers the lap band procedure so now I am trying to decide on a surgeon. I've seen alot on here about Dr. Scott Steinberg and Dr. Edward Lin. Can anyone give me a phone number, email or webpage so that I can get in touch with them?

Thanks

I had mine done by Dr. Edward Lin at crawford long on April 30th 2007. Dr. Lin is a great Dr!

That # is 404-686-8143

Or Emory HealthCare

[AtlSpeedy 0]

Does any one know anything about Dr. Joanne Williams at Emory? I think she is new, I've had two meetings with her so far, but I am considering changing to Dr. Lin.

[RomeGA3 0]

Hi fellow Georgians! Just wanted to introduce myself--I'm living in Acworth right now with my husband. I'm self-pay cuz I have low BMI, but have yo-yo'd my whole life and need to lose 60 pounds *for good.*

My surgery is with Dr. Ortiz in TJ on 1/25/08, and I'm feeling very excited and a little nervous (just a little).

I'm looking forward to continuing to read this forum. Thanks, everyone for contributing to helping make folks like me feel less alone.

RomeGA3:)

[hopefulgirl 0]

I decided to use Dr. Lin. When I called they told me the first thing I have to do is attend a free seminar where they will handout the paperwork and other items I will need to proceed. The seminar is Feb. 21st and seems like a long time away. I would have hoped to be sending my info to the insurance company before then and getting things started. For other Dr. Lin patients, how was the seminar?

[candy8360 0]

I had to do the same seminar. Not sure if each doctor does his own, but Dr. Davis was the one who did mine. You will probably find a lot of it repetetive to a lot of things you have already learned here, but it is a prerequisite to using emory. I did mine at the end of June and then made my first appt. with Dr. Davis that next week, the week of July 4th. One of the things that took me so long was that I had to schedule all the preop stuff, had to have a current physical, and my last physical had been over a year before. I had to wait like 6-8 weeks for my physical. Then set up my psych appt. Had to wait a week or so on that. I was under the impression that my insurance didn't require a nutrional evaluation, but emory insisted on that, so when I thought I had everything done, I had to do that as well. Then they submitted me for approval. I was approved in a week, and then had to go in for an endoscopy. I did that on Sept. 27. After that I had to go to a 3 hour nutrional class which you have to pay for out of pocket. It cost $180. I had to wait for the money to cover that. I FINALLY got it all done and my surgery was scheduled for Nov. 27 but then the surgeon had an emergency and they rescheduled me for Dec. 4th. Was quite a journey, believe me!!! But, I made it through. Hopefully it will not take you as long. It all depends on your circumstances. But I am sure you will have to follow the same procedures. Let me know how your seminar goes!