[ML in VA]

Originally Posted by HarleyNana

ML, so sorry about the denial, but even if you're not approved, put a second mortgage on the house or do what you need to do to gettter done!

Tricare will deny if they Cigna says its not medically necessary so I'm out as far as insurance is considerd. Already in process of looking at loans, HarleyNana. WLSC has a date available the first week in August so I'm shooting for that!

[jdutchess]

Hi all. I see that many of you are self payers. I am a Norfolk teacher and our insurance does not cover. :( My question is..what is the total cost and how were you able to pay it? Was it a lump sum, loans, or payments? Is it credit-based? I am going to NN for the free seminar tomorrow maybe I will findout there. I am just disgusted that optima (norfolk teachers) does not cover anything when I am paying a lot for insurance each month.

[ML in VA]

Originally Posted by jdutchess

Hi all. I see that many of you are self payers. I am a Norfolk teacher and our insurance does not cover. :( My question is..what is the total cost and how were you able to pay it? Was it a lump sum, loans, or payments? Is it credit-based? I am going to NN for the free seminar tomorrow maybe I will findout there. I am just disgusted that optima (norfolk teachers) does not cover anything when I am paying a lot for insurance each month.

I think its ridiculous that they don't cover this seeing how obesity is a disease! I'm self-pay at WLSC of Hampton Roads. I called them this morning to tell them I was able to secure a loan (401k) and had a date of 8/14 within seconds. No fuss, no muss! I'll be happy to provide any info you may need! Thanks by the way, for all that you do for our kids as a public school teacher!

[HarleyNana]

My cost was $16,750, (also self-pay), plus a few incidentals. I must say, insurance or not, I would do it again in a heartbeat. Dr. Terracina was my surgeon, If you decide to go to Hpt Roads WLS, tell him Pat, his first LAP-BAND^® patient, said hello.

[Stay_Tuned]

Hi everyone!!

I am a fellow bandster... allthough not able to enjoy the full benefits at this point... my port is detached...ugh! BUT anways...

It looks like my hubby and our family will be relocating to the VA beach area. Hubby is going to be working at Little Creek....He is active duty.... Does anyone know a physician that accepts tricare and does fills with fluroscopy??

Ohh and while I am at it... If anyone has the time.... Care to give me the break down on the good bad and ugly schools(highschool and middle) AND neighborhoods.... We have been discouraged at the age of homes and the price....We need a safe area with good schools....

Any suggestions?? We are open to Chesapeake too.....

THANKS so much!!

Ohh and I hope to have my revision surgery sometime in August and at that point they will do my first fill..... I am very upset with my outcome at this point.... ummm upset is a mild term I am trying not to use swear words LOL!!!

Anywho.... Thanks in advance....

[luvmy2dogs]

I go to the WLSC of Hampton Roads as well. My Dr. is Dr. T. too. I've been fighting my insurance co. for months, and today, I GOT MY APPROVAL!!!!!!!!!! HOORAAAAAAAAAAAAY!! I'm so excited I can't stand it.

[signgirl]

lovemy2dogs, YEAH!!!!!!!!!!!!!! :) So happy for you getting your approval!

[luvmy2dogs]

Thank you. I'm very happy, scared to death, but excited at the same time. I'm going to be a bandster.

[ML in VA]

Okay, so I started this journey in May 2008 after getting my PCP to agree that LAP-BAND^® is definitely something that I should consider, even though I had no comorbidities.

I had done a 6 month diet with my PCP (I had missed 2 months), nutritional consult and psych eval and had documented my 5 year weight history. Everything was submitted to Cigna - within 6 weeks I was denied due to BMI being 41.5 but not for 2 years and lack of 6 month diet. I resigned myself to the denial, but shot off a quick, emotional appeal letter (unbeknowst to my surgeon) that basically stated I know I missed 2 doctors visits, but that was only because I was losing weight and yes, my BMI fell below 40 in the past 2 years, but that was due to a liquid diet that I tried. I also stated that I met all the requirements and reattached all of the docs previously sent and advised them why I felt I needed the surgery (family history of diabetes, high blood pressure, cholesterol and heart disease) and also documented my battle with weight for the past 10 years and basically said that Cigna coul expect to pay the claims associated with these diseases that would surely come my way.

I prepared to self pay and borrowed 17K from my 401K. Surgery date was set for 8/14 and I was resigned to pay this large sum - even though I can't afford it.

2 days ago I received a call from Cigna's medical director assistant, indicating that they needed my nutritional consult resent. I faxed them this info and advised my surgeon's office what they asked for. They chuckled and said it was already sent and this is a stall tactic that insurance company uses. Today, I received a call from the medical director's assistant..APPROVED!!

Moral of the story is sometimes a heartfelt appeal with the supporting docs works; don't give up. I hope my story helps someone.

ML in VA
cw 289

[luvmy2dogs]

This sounds very similar to what happeend to me. I started in February. The first pre cert denied for nutritional eval. This was sent, but was sent to the appeals dept. and not the medical director that was reviewing the pre cert. So, the appeals dept. had the nutritional eval, but nothing else. The pre cert. dept. had everything but the nutritional eval. It was a matter of admin mess up, that took me 4 months to get straight. The other day I got a Dr. to answer the peer to peer line, and he said all that was missing was the nutritional eval. It was sent directly to him and given to the Medical Director doing the review. Within an hour of her receiving it, I had an approval. It was amazing. I was preparing my huge package to do my final appeal, and never needed to continue with it. What a nightmare it was though. Be persistent. Don't stop calling. Do whatever it takes. ML glad to hear you were approved! :-) Good luck on your continued journey. I'm being banded 9/11

[HarleyNana]

WTG, Luv and ML, that's great news. So when are your surgery dates?

[luvmy2dogs]

Hi, I talked with you several months back. I think when I was fighting the insurance battle. My surgery is 9/11. I can't wait, but scared to death!

[luvmy2dogs]

Harley, you've been banded for some time now. Weren't you Dr. T's first patient. I remember that. How is it going for you?? Do you love it? I'm still really worried about several years from now, and what the band does then. As far as corroding, etc... They really don't have any long term results as far as stuff like that goes. Have you heard anything about that. It would really suck to have this and 10-15 years later, have to get it removed for problems, etc... I would love to know anyone's thoughts on this subject. Thx. BWHD

[signgirl]

ML!!! so happy to year you were approved!!!!

[Jefe]

My name is Jeff, and I just stumbled across this thread looking for info on lapbands in Hampton, VA. I have type 2 diabetes, 5 herniated disks, High blood pressure, sleep apnea, and over the last year, a plague of diabetes related boils, one of which required surgical drainage. According to an online calculator, my BMI is 47.4.

I just saw my endocrinologist today, and she suggested I get a LAP-BAND^®. I poo-pooed the sugestion last year, but it's been a tough year. The boils are super painful, and almost constant. My sister had a traditional bypass, which scared me off, but I've been married for 9 months now, and I want a long, happy life with my wife.

I have optima insurance, which has already denied me, and no chance of affording self-pay. I'm gearing up to fight them. Does anybody have some advice, and maybe contact info for Hampton Roads WLC?