Road blocks you had to overcome before surgery...

swstacey1977 · 12-07-2007, 07:03 PM

Okay. i thought i would start this thread for all of us to vent about our pre- experience or existing experience with getting approved for the LAP-BAND®. for example. i will tell you of my journey. went to a surgeon who was covered through Aetna, my insurance carrier. paid 400.00 , plus 25 gas in my car and 25 for his nut. found out after my paperwork was submitted that he did accept Aetna but was not in his contract to do weight loss surgery with Aetna. had to find another surgeon. found one.
paid 200.00 for his consult, another 25 for his nut, 25 gas in my car. (both surgeons were 100 miles from where i live). they submitted my paperwork, i was approved. set up a pre-op appt then the surgery coordinator calls me and says , the surgeon may not do your surgery cause Aetna does not pay enough. had to wait 2 days for an answer from him. she calls me and says, oh, i am sorry. it was a mistake. i got the wrong quote. he will do your surgery after all.
that was the frustration i went through before i had my surgery.
anyone have some nightmare stories.....can't wait to hear them.
finally banded and loving IT!:clap2:

marieee · 12-07-2007, 11:44 PM

It took me about a year to do everything. I had to go to extensive classes required by my surgical group. My surgery date was scheduled for June 6th, and two weeks before my surgery, my insurance company changed their policies and I had to do a 3 month supervised diet. I was finally banded on November 14th.

juno610 · 12-08-2007, 07:52 AM

Most of my journey was pretty smooth except for this: my white blood cell count was very high and no one could figure out why. So, I had to be cleared by an oncologist (they thought it might be leukemia) before surgery. On top of all my pre-surgery jitters, I had THAT to worry about to! My count finally came back normal literally 3 days before surgery. I was so close to getting cancelled!

SpecialK · 12-08-2007, 08:31 AM

Quote:

Originally Posted by swstacey1977

Okay. i thought i would start this thread for all of us to vent about our pre- experience or existing experience with getting approved for the LAP-BAND®. for example. i will tell you of my journey. went to a surgeon who was covered through Aetna, my insurance carrier. paid 400.00 , plus 25 gas in my car and 25 for his nut. found out after my paperwork was submitted that he did accept Aetna but was not in his contract to do weight loss surgery with Aetna. had to find another surgeon. found one.
paid 200.00 for his consult, another 25 for his nut, 25 gas in my car. (both surgeons were 100 miles from where i live). they submitted my paperwork, i was approved. set up a pre-op appt then the surgery coordinator calls me and says , the surgeon may not do your surgery cause Aetna does not pay enough. had to wait 2 days for an answer from him. she calls me and says, oh, i am sorry. it was a mistake. i got the wrong quote. he will do your surgery after all.
that was the frustration i went through before i had my surgery.
anyone have some nightmare stories.....can't wait to hear them.
finally banded and loving IT!:clap2:

Thanks for letting me know your experience. I was wondering if Aetna made you do the 6 months of nutrition counseling even if your BMI was over 40, and if you had the 5 years of documented medical visits showing you'd been overweight. Thanks. :)

buckeye_jc · 12-08-2007, 08:42 AM

I can feel your pain vs these insurance companies. I'm Humana, and they basically laughed at me when I asked them about Bariatric -- any of them, but mainly the Band. I fought against them for quite some time, even looked into getting legal council, but decided just to bite the bullet and pay it myself, outta my 401k. I mean I understand the places opt out for certain procedures, to keep insurance costs down, but I still whine and complain about it:(

swstacey1977 · 12-08-2007, 10:39 AM

Hi Special K. Yes, i still had to do the 6 month diet and my bmi was 48. I did have the 5 year medical history but i understand that if you are missing some years that you can include pictures. it is strange to because on Aetna's website they ask for 5 year history but both surgery coordinators i dealth with only asked me and only submitted 3 years of my medical history. weird huh? i think Aetna needs to update their website.