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Getting Started

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Old 11-11-2012, 04:10 AM   #1
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Default Getting Started

Hi everyone! Sorry if this seems too general, but I've been looking into WLS (Lap Band in particular) for quite a long time now. I know just about everything there is to know pertaining to that particular procedure so I'm very well informed in making this choice, but honestly I have no idea how to get the ball rolling! I have pretty lousy insurance (Basic state insurance, aka Blue Advantage) and I'm not sure how to tell if they will pay for this surgery. They're really stingy about what they cover, and in the coverage guide there's an asterisk next to Bariatric Sugery that says it requires authorization from a specialist, which is where I'm confused. Do I go to my regular doctor or am I supposed to find a surgeon and start there? It seems odd to me to go the second route not even knowing if I can pay for the procedure. If they do cover it, I'm certainly qualified so that's not what I'm concerned about.

Basically what I'm asking is, for all of you lap banders out there, how did you get the ball rolling on getting the surgery?
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Old 11-11-2012, 10:45 AM   #2
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I'm not a lapbander, but I think the process is about the same, regardless of the procedure.

First, call your insurance company directly. They will probably direct you to a webpage that will explain what they cover (and what they do not cover), and the procedure. A specialist is more than likely the surgeon, not your PCP. However, they should be able to tell you directly (if you ask), if you are covered.

For me, I needed my PCP to recommend WLS to a Center of Excellence program and then I needed to not only follow the steps of that program, but also have a mandatory 6 month weight-loss attempt documented. The center I used was familiar with my insurance company requirements and made sure I was meeting the obligations of both the insurance company and their own program.
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Old 11-11-2012, 10:47 AM   #3
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Don't give up hope! the starting point will be your PCP, no matter which surgery you end up with. The PCP will take care of the referrals and much of the documentation.

Now, the reason I said 'no matter which surgery you end up with' is because not every insurance company covers every type of surgery [at least, not without some discussion]. And your surgeon may believe that a different surgery would be a better choice for you.

What that means for you is this: DO YOUR HOMEWORK. Research the different types of surgery, and what happens with each of them. Pay special attention to life AFTER the surgery - because that's how you'll be living. If you can't see yourself sticking with the eating recommendations and the vitamins with one surgery, maybe you can live with a different one.

take a deep breath - it's really one step at a time, and for now, that first step is your PCP.
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Keeping it off is a hundred decisions a day that help you maintain what you achieved. And that's the hard part. - L Sanders

start: 506 [Sept 2001]
weight at gastric bypass [Jan 29, 2002]: 409
current weight: 225
weight for plastic surgery: 200
final goal: 180

Posts by members, moderators and admins are not medical advice. See your physician before taking advice found on the internet.
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Old 11-11-2012, 06:54 PM   #4
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Thinkfit,

My first step was to attend a seminar offered by the bariatric center. I already knew that my insurance would cover my surgery, but I was required to turn in a form to the insurance clerk. She verified my insurance, then I was admitted to the program.

I also previously had attended a seminar in two other states. Seems like for me anyway, that was the first step in the three states I looked into.

I decided on gastric bypass and my surgery is scheduled for a week from tomorrow (11/19).

Good luck with your insurance company and with whatever decision you make!
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Old 11-11-2012, 11:33 PM   #5
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Thank you guys! I've got to wait until tomorrow (boo, Sunday), but I'm going to schedule an appointment with my PCP as suggested and see what happens. I'll definitely check in again to let you know what happens and/or ask some more questions I'm sure! Thanks again
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Old 11-19-2012, 01:05 PM   #6
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Just an update, I went to my PCP today and she gave me a referral to a surgeon that frequently deals with my insurance. Now I just have to call and attend the mandatory informational seminar to get it all started, but it is getting started!
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Old 11-19-2012, 06:04 PM   #7
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Quote:
Originally Posted by thinkfit View Post
Just an update, I went to my PCP today and she gave me a referral to a surgeon that frequently deals with my insurance. Now I just have to call and attend the mandatory informational seminar to get it all started, but it is getting started!
good news for sure
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Old 11-19-2012, 10:08 PM   #8
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the first step is DONE!! congratulations! the first one is always the hardest. when's the informational meeting?
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Start your day with a smile, and get it over with.
Keeping it off is a hundred decisions a day that help you maintain what you achieved. And that's the hard part. - L Sanders

start: 506 [Sept 2001]
weight at gastric bypass [Jan 29, 2002]: 409
current weight: 225
weight for plastic surgery: 200
final goal: 180

Posts by members, moderators and admins are not medical advice. See your physician before taking advice found on the internet.
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Old 11-20-2012, 12:47 AM   #9
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Rhonda Marie - definitely! thanks

Jiffypop - Thank you! I'm so excited that the ball has started rolling that I can hardly sit still haha. You're right, the first step was definitely the hardest, I was so nervous but now that I know my doctor is backing me I feel infinitely better! The next available informational meeting is not until December 20th unfortunately, but I called and got all registered today so I'll have to do a little waiting, but I don't mind - the time will pass anyway! I'd much rather be waiting on the next step than sitting around debating getting started in the first place. I'm crazy anxious though!
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Old 11-20-2012, 02:30 AM   #10
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At least it's moving good for you...and you will see how quick the date of you surgery will come!
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Old 11-20-2012, 03:19 AM   #11
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Thank you I really can't wait! I've spent the last four years giving myself "one more try" to do it on my own, but I've finally come to accept that there's no shame in a little help. I'm so excited to join all of you here. By the way, congrats on your success so far, you're doing great!
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Old 11-20-2012, 11:31 AM   #12
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thanks, Daisy - we've worked hard! honest! here's a thought - while you're waiting for Dec 20, maybe you could start making a list of some Qs you have that you'd like to have answered. just so you can be prepared ....
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Start your day with a smile, and get it over with.
Keeping it off is a hundred decisions a day that help you maintain what you achieved. And that's the hard part. - L Sanders

start: 506 [Sept 2001]
weight at gastric bypass [Jan 29, 2002]: 409
current weight: 225
weight for plastic surgery: 200
final goal: 180

Posts by members, moderators and admins are not medical advice. See your physician before taking advice found on the internet.
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Old 11-20-2012, 05:32 PM   #13
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All that hard work seems like it's really paying off That's a great idea actually! Unfortunately I got an email today saying that I need to call and reschedule as the informational meeting on the 20th had be be canceled, the office is closed for the day so I have to wait for tomorrow, but I'm crossing my fingers that possibly it was moved to an earlier date - I'd really hate to wait for next year! In the meantime though, I'll definitely get started on thinking up some questions
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Old 11-21-2012, 04:00 PM   #14
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Good news! I'm now going on December 6th!
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Old 11-21-2012, 05:05 PM   #15
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Good news! I'm now going on December 6th!
awesome
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