Hello i need help

[erikafroling 0]

Hi I am a 30 y/o mother of one son,live in a town between orlando and daytona,florida, I have done the research and im sure the lap band is what i what and need. I went to my primary doc. and he has no idea what im talking about ..after i described it .. he said well lets make sure my heart was in good shape and i am good on that ...well now i dont know what to do or what to expect? All you guys out there are such a inspiration..i was wondering if someone would let me know what i should do next? find a dr.,... find out first if ins. will cover,...what other pretest do i have to get? any help would be great...thanks erika

[jerryg 3]

Erika

I'm surprised that your Primary Care Physician (PCP) hadn't heard of the band. While I don't know what your doctors will require I can tell you my sequence of events. Also note that I have Blue Cross Blue Shield of Michigan, and that ALL insurance companies seem to be very different in requirements.

1) I received a referal to a surgeon from my PCP

2) I did extensive research on the web to learn as much as I could about all the options, NOT just the band. The research was a requirement of my surgeon prior to the initial consult. He stated that he expected intelligent question regarding the surgical options.

3) I visited the surgeon discussed all the options, potential dates for the surgery, and all the requirements that were needed to be met for insurance to pay.

4) The first requirement was a letter from my PCP documenting the medical needs for the surgery. It needed to discuss both medical and personal past attempts at weight loss, and co-morbidities such as diabetes, heart disease, arthritis, etc.

5) The second requirement was a psychological evaluation. As I understand it this is intended to check for psychological problems so that they can be dealt with prior to surgery.

6) The final requirement was that all this information had to be sent to my insurance company for pre-approval

The entire process took me about three months and I am so happy that I stuck with it. Right now I'm 20 weeks post op, down 72 lbs, and enjoying life more than I have in a long while.

[Alexandra 55]

Hi Erika,

If you are interested in having insurance cover your treatment, a good place to start is with your policy. Whatever kind of plan you have the first step will be getting a diagnosis of morbid obesity, since the band is only recommended for people suffering from that malady--that means a BMI over 40, or a BMI over 35 with two co-morbidities.

The person to make that diagnosis is your primary care physician. He or she can also establish your attempts to control your weight through diet and exercise and take a detailed history. Then he or she will make a recommendation for surgery, if it's indicated.

Then comes the surgeon. Their requirements can vary, but in my case there was a list of blood tests, a nutrionist evaluation, and a psychological evaluation. The surgeon needed to see the results of these tests before he decided whether I was a good candidate for surgery.

Once that decision is made, it's your surgeon who puts the request in to your carrier for precertification. Everyone has a different experience with that, but you can probably find out whether your insurance carrier is band-friendly before that point. If they are, it's just a matter of making sure you meet their medical criteria for being a qualified candidate.

BTW, my primary care physician had also never heard of the band. She had several patients who'd had RNY and who were mostly suffering the side effects, so she was initially very reluctant to recommend any WLS surgery. But I showed her the handbook from Inamed (available at their website) and after she did a little research on her own she was totally on board.

Jerry, your doctor sounds great! I love what he said about expecting to hear intelligent questions. Cool! My surgeon said that he felt I'd be a good candidate for any of the WLS procedures he does, but I'd had my mind made up beforehand that I wouldn't consider RNY at all. That, coupled with the fact that he was absolutely positive Aetna would never pay for it made our first and only meeting quite short. But it's all worked out, and now I'm going under the knife tomorrow. Yikes!

[marsha 0]

Hi Erika,

I was in a simular situation. My PCP had never heard of the band, only RNY. I have United healthcare PPO. I went to several "information sessions" by different surgeons in my area. (I figured out who did banding in my area from several different web sites.) Then, I choose Cleveland Clinic for my surgery. I just felt more comfortable there with the people and surgery. I did not go back to my PCP; I saw the surgeon first. He determined that I am a canidate for the surgery, and his office arranged all the tests I need and arranged for me to see a couple of specialists for surgical clearence (and to diagnose my co-morbidities). Once I get all the consults and tests done I will see my PCP for a letter of medical necessity and then surgery will be scheduled. (I'm in the process of all the tests now...it will take me about a month to get everything done). Most surgeons offices will help you getting insurance approval and any letters you need to support your claim for surgery.

Good luck!!!!!!!!!!

Marsha

[JC_GODOLPHINS 0]

Hey Marsha, who is your surgeon going to be? Mine is Szomstein, and they told me the same story, 1-2 months. That was from my initial consult with the surgeon. I already had my letter of medical necessity from my PCP. They set up all the testing, and sent all the insurance papers in for me. From day 1, until surgery date, it will be almost 7 months. I'll be banded on Aug 29th. I started everything at the beginning of Feb.

Erika, look around, I know there is a surgeon in Ocala that does the lapband, and that should be a lot closer to you. Find a surgeon, and they'll guide you from there.

BEST OF LUCK!!

[bobby_hamrick 0]

Hamilton Medical Center- Hamiltonhealth.com- Search the site for lap band. These folks are great. Also from what I have read I'd go with a Dr who has done many of these. Hamiltons close to you..

[nickyjs 3]

Hi Erika,

I can't help you out here as I live in Australia and besides all the others have given you some great advice. I just wanted to say well done on the decision and good luck in getting it all finalised.

Take care

[victoriamal 0]

as bobby stated this is a good place-he just had it at a different hospital - same dr's-same group-come to chattanooga tennesse or dalton georgia to get it done both are wonderful hospitals and same dr's who by the way come with the best creditionals!!!!!im set for september 11-20 days and counting-victoria

[Kiera 2]

I am not in the US so I won't be much help with finding doctors or dealing with insurance but with regard to your primary care doc I would suggest going to http://www.inamed.com/products/obesity/us/clinician/lapband/prodinfo.html and printing out all of the clinical info and taking it with you to give to your doctor. That at least will bring him up to speed.

There is also a patient page at http://www.inamed.com/products/obesity/us/patient/lapband/prodinfo.html which might have more info about the surgery and everything. Here is the link to their patient guide: http://www.inamed.com/pdf/health/94829E_LB_Patient_Book.pdf

[marsha 0]

JC,

Dr. Szomstein is my dr. too! I know it's going to take a long time. I started in July and don't expect surgery till Dec 2003 or Jan 2004. I originally went to US Bariatrics at Holy Cross, but they only want to talk me into RNY. I have about 85 pounds to loose and I don't care if it takes me 2 years to loose it (US Bariatric's big plug for RNY is that you loose it faster and that it's the "gold standard"!) 4-5 lbs a month is fine with me and a less risky, reversible (if necessary) procedure is why I want the band!!!!! Oh Well....in the mean time, I'm waiting!

Keep in touch and GO DOLPHINS!

Marsha

[marsha 0]

JC,

I forgot to ask...what insurance do you have?

Good luck with surgery in less then 1 week!!!!!!!!!!!!

Marsha

[victoriamal 0]

i went to a orientation on july 8 had consult with dr.july 10 and surgery set for september 11- i did all my research and got referral letters from 2 dr's and had history and called my insurance with proc/ codes for approval and was set and approved with in 2 weeks.i have bcbs of mich which had no excl. at all for weight loss surgery.my psyc and pretesting are this week and 16 days to go! so all in all from start to finish less than 8 weeks for first consult to surgery-yahoooooo i have a great dr who is a leader in this surgery did the research on him the surgery and the hospital now im psyched and ready to go yesterday.ive also lost 42 lbs in the past few months while working on this so im more than ready-good luck to you jc let us know how you are doing im right behind ya all-victoria