So upset and dont know what to do

[PSJ71 0]

HI,

I started the ball rolling with getting the lap band this past September. In November I started my testing. I have had most of it done, with the exception of the sleep study, an EGD, and attending a support group meeting. I was hoping to have the surgery sometime in January. Well, for starters, my primary care physician has not gotten my letter supporting the surgery sent to the surgeon. I found out 3 weeks ago my employer was changing all the benefits and now I have to choose from Aetna PPO or Health Net PPO. I have no idea which one to choose. I had Blue shield of CA and all they required was my psych eval and that dang letter from my primary care physician to be approved.

Now, I have no idea what is going to happen since my insurance HAS to be changed by December 30th. I know since there will be no lapse, they cant' spring the preexisting condition thing on me, but this really has me upset. I found Aetna requires a 3 or 6-month supervised diet attempt. So, basically all the money I have been out will be all for nothing I assume if I have to do that. I'm so ticked off at my place of employment for not letting us all know they were going to be doing this. I never would have started everything had I known. :thumbup:

I just don't know what to do. I have tried numerous times to lose weight, but of course, none of it is documented by a physician. If anyone can tell me how hard it was to be approved by Aetna or Health Net please let me know.

Thank you for "listening."

[Mr. Green 3]

Can't comment on the requirements of the insurance plans, but try the insurance web sites and see if you can find the plan. Most insurance companies will have the policies on the site. If not, give them a call.

[MicheleK 8]

Aetna PPO is my insurance, (my husband works for Dell Computers in Oklahoma City). They require a 3month nutrionist supervised diet plan. It's not too hard and they don't deny you if you don't lose weight on it.

Aetna did not require a psych eval for me which was surprising since I am on anti-depressants.

As far as Health Net, I don't know much about them.

[jackieva 3]

I don't know if my advice would help or not, but I was in the same boat. My employer is changing to Blue Cross HMO Jan 1, 2009. They do not cover the Band, only bypass. When I learned this in November, I had less than one month to complete the approval process. I quickly scheduled the psych. eval and begged the dr. for the results immediately, (she did, had the results sent to my insurance by the next day...try to find an independent therapist, one who works out a small office or their home...they will work for you versus a big medical group), then my psp wrote his recommendation. I will have the upper GI right before the Band while I am under. Finally, because I did not have 6 months of diet with dr., I wrote a letter detailing my years of obesity from birth and the diets attempted over my life. They accepted that, and I will be banded on the 31st. Its worth a shot.

[tripi 0]

PSJ71, the same thing happened to me. Employer switches to Aetna Jan. 1. There is a way to continue coverage through your current plan. There's a form you have to complete and get approved, and you should ask your HR department for it. All you need to tell them is that you're already being treated for a medical condition under your current plan, and you can't start over with a new doc. (If you don't have any co-morbid conditions, it probably won't work, but if your primary care can say that they've been working with you to get the surgery based on your overall health, you're probably in good shape.)

[PSJ71 0]

Wow! I didn't realize so many other employers were changing as well. Thank you all for all of your great advice. I spoke to the bariatric coordinator at my surgeon's office, and she told me I would have to undergo a 3-month supervised diet with the surgeon. After I spoke to the fitness center affiliated with it, I really don't mind doing it. I was just hoping I could have had it done sooner for the New Year, but I guess for some reason it's not meant.

As I was saying though, maybe this 3-month supervised thing will be good for me. It will help me start to work on my diet and exercise before I get the band. So, I will just embrace it and pray that after going through so much, they will approve me. So far, I don't have any comorbidities yet as far as diabetes or anything like that. I do have low back pain, high cholesterol, and infertility. So, I'm hoping that will be enough to get me approved.

Also, MicheleK, did you have to have a 5-year weight history or anything like that?

Once again, thank you all so much.

Paulette

[lapbandtalker 0]

Don't let lack of insurance stop you. It would be nice to have someone else to pay for it since you've been paying your premiums all this time...but don't let it stop you.

This procedure is worth taking money out of savings, or going into debt -in my opinion.

[PSJ71 0]

Hi Lapbandtalker,

Yes, I had thought about that as well, but unfortunately, I don't have great credit due to several issues that happened with my husband breaking his hand, being out of work, paying off the home my mother and I coowned after she passed away. So, taking a loan to have the surgery wouldn't be fruitful. Also, because of these issues that happened, I don't have a savings anymore. :thumbup:

Thank you so much for your reply.

[Florida Pete 1]

My wife used to be a life and health insurance agent and from talking with her this is the best thing you can do to help in making your decision. Talk to the HR department at your work and see if you can get an explanation of benefits for each of the plans to review. Then in the explanation of benefits see if WLS (Weight Loss Surgery) is excluded or not. This is very very important because many insurance companies will pay for it but that is only if your employer choses a plan that it is "included" in their plan. It's cheaper for your employer to not have it included. Then once you know that it is included go to the insurance companies websites and review the requirements or contact the agent representing your company to see what the requirements are for getting banded. It really boils down to your BMI & comorbidities. A lot of the health insurance companies will not require the surpervised diets if your BMI is high and you have multiple comorbidities. So best of luck on chosing the right insurance plan.

[PSJ71 0]

Hi Florida Pete,

Thank you so much for replying. From what I understand, it is covered, but I am going to contact Trinet themselves, which they are handling our human resources things now it seems. Not only did my company change insurances, but they added a company to handle the other things as well.

I just chose Aetna PPO, out of several different insurance options. But, I will double check and make sure it is covered. My BMI when I went to the doctor a little over a week ago was 50. So, I know I Have a high BMI for sure.

Again, thank you and thank your wife for me as well. :thumbup:

Paulette

[Florida Pete 1]

Glad to help Paulette!

I am sure you will do just fine in getting approved. It is a frustrating process but one that you can get through and will be well worth it on the other end.