My info still hasn't been sent to insurance for approval!!!!

gatzpup · November 6, 2007

I can't remember when, exactly, I started this process. I think it was around Feb/March when I went to the information seminar.

In August, after having my sleep study, I finally got to meet my surgeon in a short office visit (the actual visit was nothing compared to the amount of time I spent in the waiting room). During that visit, the nurse gave me a list of required testing that had to be done before my info was sent to insurance. However, my surgeon (Dr. Allen - Louisville) told me that it wasn't necessary - he said I could get all of them done, none of them done, or some of them done. The only thing is that the anesthesiologist could decide he wanted one done and it could hold up my surgery. My primary doc and I decided we wouldn't have them done. Dr. Allen told me to call his office if I hadn't heard from them (on whether or not insurance had approved me) within 30 days. So, around mid-September I called only to find out that they were waiting on me to do the "required testing." I told them what Dr. Allen had told me and they said that was not correct! It sounds like they need to have a staff meeting there!

Anyway, my primary doc arranged for me to have lung tests, an ultrasound of the legs, an ultrasound of the heart, and more blood tests. I got them all done in one day.

The results were sent a few days later to Dr. Allen's office. After a while, they called to let me know they were missing two things: a letter from my pcp stating that I have been alcohol/tobacco free for 1 year, and my electrocardiogram results. She also wants proof of 6 months doctor supervised weight loss - she said it wasn't absolutely necessary, but would certainly help my case. OMG - - - this is driving me crazy. I do not have notes to support doctor-supv weight loss. I have canceled checks for weight watchers, nutrasystem, and a personal trainer over the past 3 years. I didn't keep any paperwork from these things, because I didn't know I would need them.

I'm about to loose my mind. I am right at 35 bmi and was told not to loose any weight since I was so close. That's not been good for me - as I've been eating whatever I want and have probably gained 5-10 pounds. This, combined with the weight I've gained previously, has caused me to continue to feel bad - hips hurt, feet hurt, etc. I am so ready for this process to be over and to start on my lap band journey. I have kept leaving messages for Celeste at Dr. Allen's office to find out where we stand, and I've not heard back yet.

If you're still reading, thanks! I know this is a long message, and that I'm probably not the only one who is frustrated during this stage. I only hope that I get approved by insurance after getting this far (and spending the money I have spent so far).

Chris61 · November 6, 2007

I would suggest that you make an appoitment with the doctor to go over all the records that you have submitted to him, and also ask to have the person who writes the letters in the room at the same time and ask why things have not been done and when they expect to have it done and send into the insurance company and that you wish to have a copy for your records. I would also have your pcp send a letter with his backing. If you would like to see an expamle e-mail me at vcw61@excite.com and I will forward you a copy of a letter that work for my wife and I.

I hope that this will give you some ideas on how to approach this.

Chris

Shelby · November 6, 2007

Also, contact your insurance company to confirm you have coveraged for lapband and what their requirements for approval are. I'm sure Celeste has a wealth of knowledge with this process but the requirements from your insurance company should be the list you both are working from.

Hang in there. It is frustrating but don't give up! Keep us posted.