Expensive Program fees and WLS

mariem · 05-25-2008, 08:29 AM

I went to the orientation yesterday at WLIA. I have to say I was impressed with Dr DeBarros and I liked that they made it seem as if it was so much easier to go with them because they will work to make sure my claim will be approved and will go the extra mile.
What I didnt like is the fact that the insurance I will be on will most likely cover 100% of the surgery with no co-pays yet I will still have to pay a co-pay and a deductible. This is because one of the doctors (and both will be there during the surgery) is not on the BC/BS plan. This most likely means my totally covered 100% procedure will cost me around $2500 - $3000 when you also take into account the program and other fees.
I have a few things that I am a bit worried about. First of all I dont have a primary care physician and my records are very sketchy over the past 5 years. A couple trips to urgent care for strep throat, a visit here and there for other things but nothing with exclusively one doctor. Other than that I'm pretty much a "healthy" person with a BMI of around 42. No, I dont consider having a 42 BMI to be healthy but I dont have any other problems. My weight has fluctuated a lot over the past 5 years but I've always been around the 40 BMI range.
I am now really regretting not seeing one doctor and having that person have all of my records. (Does urgent care even keep records easily at hand for the person who came there only once three years ago?)
Ok yes, I know this is getting long so I'll cut to the chase. I went to WLIA and they are asking for $2000 in program fees and other incidentals. Is this normal? It's sort of worth it to me if they can get me approved because of my sketchy past where others wont do much to get me approved.
Simply put are these programs fees the norm and how much do the other places do to get you approved for surgery?

elaine3758 · 05-25-2008, 08:41 PM

I went through the Bridges program. I alos have BC/Bs my program covers 90/10 so my out of pocket was around 2k. I'm not sure about participating physicians though I used DR Johnson and he was great.

SueAZ · 05-25-2008, 09:35 PM

I used Bridges Centre out of St Lukes. I have a different insurance and they only required 1 year health records. I would talk with different people who deal with the insurance companies directly. Banner out of Phx also has a bariatric center of excellence. Their bariatric person was really nice.

mariem · 05-25-2008, 10:56 PM

I was originally going to go to Bridges orientation but they scared me off by telling me I needed to be on a 6 month medically supervised diet.
When I called WLIA they told me that according to BC/BS of Mass. that there was nothing stating about a 6 month medically supervised diet, (though it would be in my best interest to get to a primary care doctor and get started on a relationship with her and talk about the lap band and my goals etc) I just have to have documentation of my weight over the past 5 years. I also asked Bridges when I called when would they actually look into what was needed to be approved and they informed me they would process everything when I was done with the 6 month diet. Maybe I just need to call them again and see if I get a different answer?

forgve70x7 · 05-25-2008, 11:25 PM

Mariem,

I have Federal BC/BS, and now have to make sure all of my appointments are under DeBarros. I too loved their program, and was sad to see Orris not renew his contract with BCBS last year.

That being said, the reason they ask for the 5 year medical history is because of their experience with insurance companies. The more data they have, the better chance you have of being approved. Also, most insurance companies require that much data. I would definitely find a PCP now though and start a relationship with one, because for surgery, you are expected to get PCP approval prior to surgery and it's good to have someone else to go to for things too.

I would call those Urgent Care facilities and figure out if they still have the records. My guess is they should have them (even if they are in storage). Mostly they want the records to show your overall health and most importantly your weight. The 5 years is usually what insurance companies want to show you have been over weight for that long and that it hasn't just been in the last year or so that you have gained the weight.

I hope this helps, and feel free to message me with other questions you may have!! :)

~Nichole

SElaine · 05-26-2008, 10:26 AM

Mariem,

I think it's smart that you are looking around, getting information, and checking out all of your options.

I haven't seen her around in a while, but if you can reach her through PM, I would try to get a hold of BandaPanda. I don't remember what insurance she had, but I know she faced quite a nightmare with it going through True Results. She was all ready for the surgery and it was either the day before surgery or the day of surgery they told her they couldn't get the proper insurance approval. She then went to WLIA and got approved right away and had surgery.

I was a cash pay patient and I know I paid more to go through WLIA than I would have elsewhere. I went to several seminars and talked to several people before making my decision, too. I feel I made the right decision for ME and would do it over again.

Not all docs and all programs are created equal; But, neither are the patients. You need to find the doc and the program that's right for YOU. Like Nichole, I'd be happy to answer any questions you have.

Good luck with your decision!

AZChick289 · 05-26-2008, 11:04 PM

Hi there I just had my surgery done on the 19th by Dr. B .. We had to pay about 3000.00 out of pocket. I feel it is totally worth it for all that comes with the program. I would talk to th einsurance people there first and see if they can help you ..Explain to them just like you did in this e-mail..It is a great clinic and dr. DeBarros is AWESOME ... Before paying though make sure they can help you ..They do go the extra mile to help in everyway .Wish I could say more but they the clinic will have you take many tests but your insurance will pay for that .. WLIZ is very through .. I think you have a great chance just don't give up ...
Kathy

kristiebandy · 05-27-2008, 01:37 AM

I am also going through WLIA. I have been really happy with their service. They are more expensive. Going with them is what is right for me. I did save $400 dollars by going through my insurance for a phsyicology evaluation. My co-pay was $20. They dr the institute uses is not covered under my insurance. Regarding the recording your weight, the institude will have you list ALL doctors that have seen you. Even your obgyn can chart your weight. All health professionals that have weighed you keep records. But keep in mind they will do the work. You give them the health facilities. You can help by pulling together any records you have or diet documentation. You do have to make a $500 inviestment to get started. I would decide what doctor you want and move forward. I kind of looked at the $500 as a start. If I had not been approved we would continue to appeal or do the suppervised diet thing. The institute can do the suppervised diet. Good luck!

mariem · 05-27-2008, 09:16 AM

Kristiebandy
So when did you start this process? When was your orientation? Do you feel you are having this done much more quickly than if you had gone somewhere else?

kristiebandy · 05-28-2008, 12:36 AM

I went to an orientation in February. I do think my process went really s,mooth and fast. However this could be my insurance. One thing that I liked about the WLI is that they give you set goals to work on for getting to your surgery date. At onepoint I was waiting for some documentation and I was able to email back and forth with Mike the dietician. I think us communicating cleared up and issue that might have prolonged my band date. What are your other options in the valley?

Ezma · 06-01-2008, 09:06 AM

Mariem - I had the exact same problem as you with them, only one doctor covered by my United Health Care insurance. I ended up using Banner Gateway Bariatrics. They did a great job of coordinating everything I needed to get the insurance approval. I know they have monthly information seminars but I'm not sure when the next one is. Their phone number is 480-543-2606 if you want to check them out.

AZChick289 · 06-04-2008, 06:35 PM

For all you to be banders with WLIA ..All I can say is you are in great hands ...
I went to my first post op appt yesterday and the staff just makes you feel so important and you are never rushed .
I can't say enough about Dr. DeBarros .He answers every question and Mike the dietician is right there for any questions ..I don't know Dr Orris that well only met him once but he too is so professional and helpful in everyway .
Even my incisions are hardly noticeable except for the bruising ..
Congrats on your new adventure .It goes fast and you are going to feel so much better .
Keep us posted .

http://tickers.tickerfactory.com/ezt...IdV/weight.png

SElaine · 06-04-2008, 06:50 PM

AZChick,

I'm so happy to hear your post-op went well! :biggrin2:

KayBee-- thinking of you and wishing you the best of luck with your upcoming surgery. You are almost there!

AZChick289 · 06-04-2008, 08:18 PM

Thank-you SElaine... I spoke of you yesterday at my appointment..
It was all good...
I am finally figuring out to get around now on this site.. I love hearing all the news ..
Hey how are the fills .Havent' experienced that yet ...
After the surgery and the Levonox shots hopefully fills will be a breeze.
http://tickers.tickerfactory.com/ezt...IdV/weight.png

SElaine · 06-05-2008, 06:20 PM

Hey, AZChick! The fills are not bad. I assume you'll be going to Dr. D for your fills, right? They'll take you back into the room, do an ultrasound, and mark your port. Then Dr. D comes in, numbs the area, pulls out a big needle (don't look!), checks the saline level, and adds saline. It doesn't hurt but you can feel a lot of pressure. Then they'll have you stand up and drink a bunch of water to make sure it goes down. That's it!

How are you doing with eating now? Are you hungry at all?