New to site-waiting on ins. approval

Mikie in VA · August 26, 2005

I've been looking at obesityhelp.com. Found this site when someone posted it there. Started the research a few years ago. Late last year I went to 2 drs. and various seminars in MD and VA. Was denied because my work ins. didn't cover lap band, only gastric. Saw a dr in VA, and really liked him-Dr Chebli (sp?). Was waiting to get re-married, move to a newer house, 2 kids graduations, etc.

So, this year found out on the BC/BS CareFirst providers website that as of June 13, 2005, they no longer consider the lap experimental. "Obesity and Morbid Obestity, 7.01.36. New technology/--aparoscopic adjustable gastric banding for treatment of morbid obesity. Description--Placement of a silicone band around the upper portion of the stomach, to restrict the patient's ability to ingest food. CareFirst and CareFirst BlueChoice Determination--If it's 'Considered medically necesary when treating morbidly obese patients who meet the established criteria for surgical intervention. This is a change from previous policy.'" There isn't a CPT code, but a HCPCS code, S2082. Found at another site that there is HCPCS S2083 for adjustments. Was told my the dr nurse in MD those codes are for hospital coding.

So, it's a wait and see for now. Paperwork was sent this Mon. Nurse told me 2/3 wks to hear. Person who does it is out-other's are handling in her absence. The kicker could be if my employer didn't have a special rider for WLS. Not sure? Could be an appeal coming my way. Lots of co-morbities. Take too many medications. Rheumatologist's visits increasing lately.

Said way to much for now. But, wanted you folks to know what I've found out. This is such a great site! Glad I found it.

Glad to communicate w/you all. Finding folks in VA/MD/DC area to meet in person. Don't think there are enough support groups, even for this large metropolitan area.

Maybe TMI? too much information

La_madam · August 26, 2005

Hi Mikie Welcome to LBT..that is the best site in my opinion. Lots of love & support here. I wish you the best on your insurance approval. I hope they approve you and you can get going on a happier healthier life

nickie456 · August 27, 2005

Hi Mikie,

Glad to have you here, hope you have good luck with your insurance. I was self pay, so I don't have any Ideal what all you will have to go thru with the insurance.

Mikie in VA · August 27, 2005

I appreciate the support. I'll keep you posted.

the best me · August 27, 2005

Oh there is (almost) never TMI on this board. We love all the scoop, so keep it coming! Best of luck to you on your incurance coverage. let us know how it turns out.

Welcome to LBT! so glad you found us!

novalady · September 30, 2007

Hi Mikie,

This is my first time on this site and it's good to see folks from NOVA. I had my surgery on 13 June with Dr. Denis Halmi in Woodbridge, and he is wonderful.

I, too, have spent time on www.obesityhelp.com but found most of the folks from Virgina are in the Tidewater area and they have a strong support group. I couldn't find anything in NOVA except for the monthly meetings set up by my doctor's office.

If I can help you with any questions about the surgery or Dr. Halmi/Dr. Tran, please let me know.