Freakin' Out in Michigan

Pam in MI · June 26, 2007

:omg: Hoping to have surgery in Aug. My insurance co. pays for it - 100% - yes VERY LUCKY, but I still don't know what the insurance company's prerequisites are. Until today I have been cruising along with hardly a minute of nerves. Today I am a basket case! :help: Met with the Psych last Friday, and she passed me with flying colors. Said I should do very well post op. Talking to the dietician this week sometime. She's calling me instead of meeting with her since the dr. office is over 3 hours a way. Seems like everything is going really well, huh? So why the heck am I freaking out????????????? I want to cry, :think but my boys have a friend here. I pigged out on cheesecake. I know - shouldn't have bought it, but a month ago I told my youngest the next time I went to Sam's I'd buy it. So there it sits in the fridge...2 pieces down...thank God I have this place to read everyone's messages and just vent...Thans for reading my rant...

Just figured out how to use these icons...

faithmd · June 26, 2007

Pam, at 0800 tomorrow morning, I want you to go and get your insurance card, then go to your telephone and call your insurance company. Tell them you want to have adjustable gastric banding done and ask if they have a special procedures case manager who takes care of the bariatric cases that you can speak with. If not, then speak to whoever can help you figure out what the requirements are. Have a pen and a pad of paper handy, write down the name of every person you speak to and note the date and time. Make notes of what they say. Most big companies have case managers that deal exclusively with special procedures like this. If not, then with the codes below, you should be able to get somewhere with the rep you talk to.

The codes to ask if they are covered are:

laparoscopic surgical adjustable band:Procedure code 43770; diagnosis code 278.01

Once you have found out from them what the requirements are, ask them to snail mail (and email if they can) you a copy of those requirements.

Pam in MI · July 6, 2007

Thanks. I did read your reply when it was first posted but didn't have time to reply. I hate insurance companies - burnt too many times - so I called the rep at my doc's office. She was wonderful. I have bcbs and she sent me the "Anthem" and I feel so much better! If my paperwork hasn't been sent in yet it should be tomorrow. According to the anthem - whatever the heck that means - I definitely meet the requirements since I have comorbidities. Thank goodness I do because my bmi is 35. Are you a doctor? Figure you are with the md in your name and the codes that you knew. Thanks for replying. No one else did, but I really didn't expect it. It just felt good to type away my stress!