I was happy..then sad! Need some feedback pls!

bobbiezhere · June 3, 2008

Ok..been waiting for approval after talking to my pcp right? I call and finally the woman says "you were approved! You will get a referral letter in the mail". I'm on cloud 9! I get the paper...uh...its not an approval for the lap band procedure..its for the nutrition program- it just says a session - weight management program. Hmm..doesnt sound like approval for procedure to me..buti figure..ok..maybe i'll get another letter. I call the dr. office - they tell me "oh...your procedure was denied". I was like "what? denied? are you kidding me?". Well, the other girl in the office told me that this is a journey..and that i do need to go to the nutrition doctor anyway - to do that step, then the nutritionalist will send a report and then they will resubmit for my procedure. Well, ok i can understand that...but...hearing "denied" made me very upset!

Oh, and when i called insurance - THEY told me "your doctor submitted for Bariatrics surgery--gastric bypass. they need to resubmit for lapband". So..isnt bariatrics surgery EITHER OR? Meaning one of the two procedures?

Sigh....so i went from extreme happiness and highs to upset and lows. But i made the nutrition appt...and after i will keep calling and askign them to resubmit.

One more questions tho...i have high blood pressure and diabetes...so i'm a good cAndidate..but i also think i have sleep apnea. Should i mention this to my doctor - will having that diagnosed as well push me over the top into the approval field?

Thanks all!

jenhay · June 3, 2008

Bobbi, i am afraid i wont be much help. i am new to this site and really dont even know how to use or post a "thread". all i can say is to keep trying. i have been working toward my lap band since late jan. and can almost see the light at the end of the tunnel.

terrasmom · June 3, 2008

Yes you definately must tell your doctor about the sleep apnea!! Dangerous to go into surgery without giving him that information!!! Also my insurance company had to have three things "presenting" as a result of my weight, and yours may be the same. I also got the doctors treating my conditions to write the insurance companies letters for me. Hang tough, it WILL happen!

BandedButterfly · June 3, 2008

Hello! Dont get depressed!! From what it seems you started your journey begining of May. I started mine Nov 07 and was approved for April 08. Gastric bypass and laband are defenitely two different procedures to the insurance company. My insurance actually doesnt even cover the by pass surgery just the lapband. Wording is EVERYTHING when it comes to insurance companies. Just go to your nutritionis apt because you have to see one anyway. And talk to your doctor!! Come right out and ask them....How are you submiting this? What wording are you using? And of course tell him about all conditions you feel you are having symptoms of. I know at times it can seem like its never going to happen...but it WILL, you just have to be persistent. And get them what ever it is they want. If you do that then they have no way of telling you: ITS BEEN DENIED. So good luck and keep going!!!