I could really use some advice..

[GramaLisa 0]

Hi everyone,

I have really enjoyed reading all the posts;they are very informative. My problem is that I don't feel like the surgeon's office is doing much to keep me informed of what I have to do pre-op and what is going on with my insurance.

I responded to the WLS flyer I got in the mail. I called and they asked a lot of questions and made me an appt. to see the surgeon. Somehow they forgot to mention that it was also a seminar and a lot of people would be there. We had the mini-seminar and they we were placed in rooms until the surgeon came in to speak to us individually. First of all my BMI is 37 but I have several co-morbidities--GERD, high cholesterol, high triglerides, degenerative disk disease, arthritis, etc. No high BP or diabetes. The surgeon said I would probably not be approved but they would try. That was May 17.

On May 23 Julian who works for the surgeon called and we spoke, again, tons of medical questions that I had already answered. He said a nutritionist and psychologist would call for interviews. He seemed to think that I would be approved by my ins., BCBS FED PPO. Julian said that after the two eval's they would send in a packet ro my ins. requesting the surgery.

May 23 the psychologist called. She said I raised no red flags that would exclude me from surgery. (I live more than 100 miles from West Hills, where the surgery center is)

May 29 the nutritionist called and we spoke. She recommended some books which I have bought and read. She sent a packet of dieting tips for before and after.

After the two calls I called my ins. company. They said they cover the surgery for sure but they couldn't tell me much in the way of ANYTHING. They didn't know about BMIs, co-morb's, exclusions, etc.

So then on June 3 I received a letter from my ins. Apparently Julian had already asked for approval prior to the two evals. They asked for the two evals to be submitted, a copy of a sleep study, the doctor's pricing and the name of the facility. A copy was sent to the doctor as well.

I called Julian for an update on June 16. He said he would get back with me. Two days later and I am still waiting. I feel like I am getting the bum's rush! I have no idea of what is going on, do I have to do a sleep study and where, am I getting the surgery and when, etc. Should I keep calling Julian and press him for details? Should I sit and wait??? I really need some advice! Thanks, Lisa :cursing:

[Jodi_620 37]

Your situation is very different from mine, it seems unusual to me to have the Psych eval and Nutrition Education over the phone. Are you clear on what you should eat before and after surgery, how you should eat, complications and what you need to do to heal after surgery? If your surgeon is not educating you then maybe he/she is not the best choice. The band is a tool and is only going to work if you are educated on how to make it work for you. And if you are not well educated on how to care for yourself post-op it could cause some serious issues.

But as far as timing, it doesn't seem to be taking any longer than it does for most people, you are actually moving along faster than many. It can take time to get insurance approval (the insurance companies are not usually in a big rush to approve an expensive surgery). Depending on your insurance it could take weeks to get approval answers--that is, once all of their required information is received.

If your insurance requires a copy of a sleep study then Julian should have already set up a sleep study for you...so yes, you should call and ask about that. The longer it takes for them to get their information the longer it will take to get approval and surgery.

Just make sure you feel comfortable with your surgeon, not only will he be operating on you but he will be the one to maintain your weight loss now and into the future.

Edited June 19, 2008 by Jodi_620

[KD8888 0]

What you need to get him to do is get your sleep study and your 2 evaluations scheduled asap. You won't get insurance approval until they have the test results.

They should be able to tell you which hospital(s) the doctor performs the surgery, but the date won't likely be set until after you have approval.

By the way, I think BCBS does have specific info available. You may need to speak to someone else. I have a different BCBS, but they directed me to a specific website address that gave all the particulars. I was also required to complete a 6 month medically supervised diet prior to approval.

[Sue Magoo 71]

Hi:

I would recommend that you consider looking for a different surgeon. If you're having trouble with follow up on their part now, imagine how it will be after you are banded? This is a long-term relationship you are building with your lap band and lap band surgeon with years and years of follow up.

I hope it all works out well for you.

Sue

[Chellets 0]

I can't speak about your dr, but I also have BCBS FEP. My BMI and co-mos were very similar to yours. I wasn't required to do sleep study for them. I was told by 3 different people at BCBS that you have to have a BMI of 40 or a BMI of 35 with a co-mo. My PCP sent a letter of medical necc, a refferal to surg, I then had my psych eval. Surg office sent to insurance and I had approval within 2 weeks. Make sure the surg and facility are in network. Because mine are, I was informed I will have a $40 co-pay- THAT'S ALL!!! The most important thing to remember is that this was my experence so far, yours may be a lot different. Each office does things a little differently. I would agree with others, if communitation is hard with your surg office, you may want to keep shopping or at the very least, tell them your feelings. See how they react to that, then decide. Good luck to you, I know this part can be very frustrating!

[GramaLisa 0]

Thanks so much for all the replies, I enjoyed reading them. I think I am going to start by calling the ins. company today and see what they have to say. Maybe I will have to schedule the sleep study on my own. I am going to keep in mind that if I don't get answers I can live with from my surgeon then I will shop around for a surgeon who can provide the answers. Thanks again! Lisa

[GramaLisa 0]

Hi again and thanks for the advice. I listened to you guys and my instincts and called my insurance company. Boy did I find out a lot today! First of all the surgeon is NOT on the PPO list which would mean more out of pocket costs for me. Secondly, I found out from the insurance company that the surgeon's office is not responding to their pleas for more information. I went to the BSBC website for my area and I have found a hospital much closer to home that is on the list and provides bariatric surgery. I am calling RIGHT NOW for the first available seminar. BTW, the surgeon I was going to use is Joseph Naim in the West Hills area of CA. It's over 100 miles from my home. The new place I am contacting is in San Bernardino, and to us High Desert people, that's just a "drive down the hill."

[Jodi_620 37]

That is wonderful GramaLisa!

The whole situation sounds better all around...good luck and let us know how the seminar goes!

[Chellets 0]

That is wonderful news! As far as insurance goes, I have had no problems with BCBS FEP. I hope it goes as smoothly for you! Please keep us up on your progress!