Hi

[chicakms 0]

Hi, I'm new. I've been thinking of getting banded I went to the information session and today I met with the doctor.

I'm feeling very discouraged :smile2: When I talked with the PA he made it seem like I was a good candidate and would be able to have the surgery. Then when I met with the doctor he didn't seem as optimistic. I am 5'3" and 210 lbs and my BMI is 37. I have high cholesterol and triglycerides that are treated with medication and thought those were on the co-morbidities list but the doc didn't think they were so serious...he said had I had high blood pressure or diabetes then we would more than likely get approved.

After meeting with the doctor we met with the insurance coordinator. She also didn't seem as optimistic. She said United Health Care is one of the tougher companies to get approved by. She told me to go to my doctor and try and get a 5 year weight history showing how much my weight has increased in the last 5 years. Then she would submit with a bogus tentative surgery date to see if they would approve.

Did anyone else have these problems?

[melinda_205 0]

Dont give up before you get started! They are being honest with you and that is a good thing. Now you need to go to the doctor and get your weight history. Have you ever had high blood pressure, back pain, depression, or anything that was treated by a doctor related to your weight? I ended up being a self pay but those are some of the things that my doctor ask about when they were trying to get me approved. Diabetes is usually a for sure bet but I dont have diabetes and even though I DID have high blood pressure, my weight has been up and down so much over the years that bcbs refused to pay. Good luck and talk to your primary doctor before throwing in the towel.

[chicakms 0]

Thanks Melinda:smile2:

I don't have high blood pressure...but I'm sure it's in my future because both my parents and older brother take medicine for it.

I do have anxiety/depression and I'm currently seeing a psychiatrist and psychologist. I think most of the anxiety/depression is related to the weight issues.

I just feel so discouraged. My PCP doctors office is staffed by morons they're always losing things and messing things up. I've been in the room with my doctor more than once when she was reading my chart and she finds papers that don't belong to me in my chart..there is a patient with a similar name to mine. They also mess up my dad and brothers charts up because they are a jr. and sr. I don't think my PCP will be supportive of this- she has known for years the weight has bothered me and she always pushes the South Beach Diet and exercise on me or pills. She's put me on numerous ADD medications because their side effect is weight loss. Antidepressants are what caused this stupid weight gain in the first place. :smile2:

I'm gonna call and see what the PCP can do for me. They also gave me a prescription to have blood tests and xrays done but they said wait until we know if I get approved.

I just read you self paid and it was $12,000....We did discuss self pay but the coordinator said the hospital alone would be at least 10,000 and that doesn't even take into account the other fees like anesthesiologist and other costs. I'm collecting unemployment right now so thought it would be a good time to get it done but the unemployment runs out in a few more weeks. I wish I had thought of this earlier when I was first laid off last Oct.

Edited September 4, 2009 by chicakms

[melinda_205 0]

I know my surgeon would also have used stuff from a psychiatrist if I would have had it. If you dont think your pcp will support you on this, just have the office to fax it to your surgeons office, let the coordinator look through it and see what she thinks. (most doctors offices will charge you for your own records but not another doctors office) then you can get a copy from them. Also, call your insurance company tomorrow, ask them what the guidelines are for bariatric surgery. Get all the information that you can get before you start diving in...know what all the rules are and start digging up everything you will need. What state do you live in?

[chicakms 0]

I live in NJ.

I've been to so many different doctors I don't think getting my weight history should be much of a problem.

How long did the whole process take you from beginning to end?

[melinda_205 0]

I started checking into everything around July or August 2007, not sure but I think that was it. The doctor submitted everything, then they said I had to do a 6 month supervised diet, so I did that, which was over in December. Then they said that my bmi wasnt high enough, so he sent in everything on my bp and shoulder pain, then they checked the weight history again....saw where I had lost weight on the Atkins diet 2 yrs ago, and made a final denial then. I called back to ask when that time period would be up and they said July of 2010, if I still had medical problems if not it would be 2 yrs past that! Getting all that information and getting the final denial took until about Feb, the surgeon wanted to do the surgery on Jan 4th, and I even had a heart cath during the waiting time bc I had some false readings on a test. After getting denied I gave up and figured it would never happen but after I decided to self pay, it took about 3 wks and that was only bc I had to do a 7 day pre op diet and had to cancel it and move it back a week so I could work around class and clinicals. All those hoops to jump through and it didnt help me at all but I had bcbs of Al. I know there are a bunch of people that dont even like the idea of going to Mexico for surgery but others have said nothing but good things about it. There are also many, including myself that just cant afford to self pay. Thankfully my mother has wonderful credit and got a medical credit card for me to have the surgery. So to answer your question it was probably close to a year. :smile2: