All my efforts...down the tubes today...

I just received a devastating call today from my surgeon's office. I was told that my insurance (Aetna) would not cover the lap band surgery because it is considered "out of network". Have spent months going to appointments, support meetings, behavior mod classes, nutritionist, losing 18 pounds... I can hardly see to type this through my tears.
I am a diabetic on oral meds and insulin (5 different diabetic meds in all). The next step is an insulin pump if I could not lose the weight and get my blood sugar under control. I already have some diabetic neuropathy. Last year, I was hospitalized for urosepsis, and was in septic shock and was in a coma for 12 days, on mechanical ventilation. I am only 52 years old, and newly married. I don't want to die. I have a beautiful 13 yr old son and a husband I adore. I am still paying off my medical bills for last year's catastrophic hospitalization. How can I pay out of pocket? I was told that my husband's insurance won't pay anything if my primary insurance won't pay.
I don't mean to be such a downer. I know that many of you will understand how I feel right now. Just needed to vent..

Rachel

Can they provide you with names of doctor's and facilities that are in-network??

I would call your insurance company for clarification. Don't give up!

I asked already - there is a surgeon in town that is just beginning to do lap band surgery, but he has not had the experience that Portsmouth, NH bariatric program has had. I don't want to go to a "newbie" to perform this procedure on me. Thanks for your response. I appreciate it.
Rachel

Is there an appeal process you can go through? I'm assuming this is a covered procedure under your policy and if the only doc they will cover isn't experienced maybe you might have grounds for an appeal? It certainly doesn't hurt to ask!

Good luck!

Perhaps there is someone nearby in another town, broaden your search. I have Aetna too but they are strict on out of network. Don't give up!!!!

The opperation in not hard, a newbie will do a fine job.

I agree, it's a very simple, 45 min. operation and one hour in recovery and then you usually go home that day. Don't give up. I will keep you in my thoughts and prayers and pray you can work something out. I had to end up being self pay so I know a little bit about what your going through. Keep us informed.

Don't take this the wrong way, your life & your call, but if death is the alternative, is a "newbie" that bad?

If I read correctly, your fears are now that you will die due to things related to your weight, but not confident that's enough to help you get the weight off in & of itself. Death, or a trained surgeon who has limited experience... all surgeons were newbies at some point, and if someone didn't go to them, we wouldn't have the experienced practitioners we did today.

Hi Rachel - that's really hard!

I tend to agree with the comments about the surgeon being a newbie at lap-bands. It wouldn't be my first choice, but if it were that or no band I would seriously consider it. Esp if he/she is an experienced surgeon overall and I got a good feeling from them.

Sometimes things don't work out just as we planned, but that doesn't mean they are bad. Take a breath and look at your options again. Our choices are rarely ever "A" or nothing. There is usually a B and a C....write down the pros and cons if you need to.
I think it would help.

How fustrating for you Rkidder...but I agree with the others...dont give up keep on persevering somewhere you will find an opportunity for you to go through with your plans.
:) becky

Rachel, don't give up hope. She if they can take him out of network with explanation of surgery. Mine did. I have United Health. Otherwise I would go to a new surgeon who they provide and they should take your nutritional consult and your psych eval. Don't fret, you can work this out.

Come on down to Boston. I don't know what insurance you have but all the major boston hospitals do the lap band and i would hope are in your network. A little ride may be worth it. Goodluck!

I'll throw in my two cents

i was banded in Oct by a "newbie". I have had ZERO complications, never used any pain meds and didn't have any of the problems that I read about (gas pain, pb's, etc). Of course, everyone is different and I am not saying that my experience is soley due to my surgeon.

What I will say is that sometimes when a dr. is a "newbie" at something they are also up do date on the newest research. Sometimes, they can also be more "thorough" with their exams.

Please don't give up, I don't know where you are from but ask the dr. for references, thats what I did and I would refer my dr. to anyone. I am thrilled I chose him.

Best of luck

Sometimes "newbie" surgeons also have a proctor in the room with them during surgery. I would call the other doc and ask about his training. Also try www.lapband.com for a list of surgeons that do the band in your area, you might be surprised at how many there are. ~Mandy