Hassle of getting approved

[lleezaz42 1]

Hi all,

I am glad i finally found a place to share my story.

I started back in Nov of 2013-"YES!" the doctor said. "you are a candidate for lap-band". I have a 32 bmi. But they said they could do it because of my high blood pressure and depression. So my journey begins. i start off with a psych eval. Which i passed with flying colors. Now i need to do 6 months of nutritional counseling. Okay, i can do that. In between i need to do a sleep study which will be done at a facility 1hr and 45 min from my home. Okay, i can do that. Went for the sleep study, i now have sleep apnea. 2 weeks later i need to do another sleep study so they can fit me with a machine to sleep with. I also had to have a EGD (?) scope down my throat. and a heart stress test. I now learn that i have a hiatal hernia. (wonderful). Still hopeful. Now after all this and 6 month later, i call to see if i can schedule my surgery. Oh yeah, the thing i forgot is they are billing my insurance for big bucks!!!. Thousands of dollars. Okay so now, they say they don't know if i can have the surgery or not because my BMI is too low. The surgery coordinator is now trying to convince the Dr i need this surgery. But what they can do is operate on my hiatal hernia and i can just pay out of pocket $3500.00 FINE. i can do that too.... but now she says the Dr isn't sure he wants to operate on me. WTH? I am now at a 50/50 chance of not having the surgery. Please someone tell me they have been thru this as well. I am so discouraged. I'm not even mad, just discouraged. Why would they put someone through all of this just to say no? They didn't even send in an approval request to my insurance company yet.

Any advice?

[BigGirlPanties 957]

when they do the hernia...they can do the WLS...many doctors do them at the same time...

Did the doctors office give you a better explanation? BMI isn't the only factor... sleep apnea is another reason you can get it, along with others...

call the doctors office and get answers... you can also call your insurance company for specs on getting it done...

Good luck

[Terri160 11]

You might need to go to another dr. You keep saying it's the dr that is not sure. You should qualify with as little as 30 BMI by FDA standards with either high blood pressure diabetes or sleep apnea. My insurance would not pay for my band but they paid for my hernia repair. I still had to finance 6900 though. Just had my surgery may 7th. I started my process in April. So mine moved pretty quick.

Edited May 9, 2014 by Terri160

[lleezaz42 1]

Thank you Ladies. The next time i speak with the coordinator i think i will let her know i will be going to a different doctor. I found this one by signing up online for a seminar and they said yes i would be the perfect candidate.

[2muchfun 8,927]

You should get a 2nd or 3rd opinion from a surgeon who does Lapbands. The FDA approved the band for BMI's of 30+ recently.

[lleezaz42 1]

Can anyone give me a name of a dr in the southern cali area.

[2muchfun 8,927]

There's a search engine on this site for surgeons near you. On a PC it's at the top and bottom or click on this:

http://www.bariatricpal.com/surgeons/