Another February Bander!

Hello all- I've got my Lapband date Feb. 20 with Dr. Oh. Now I'm getting nervous! Not so much the normal questions- Am I doing the right thing, Will it work for me, What would I look like skinny? but will either of my insurances pay? I am covered by Federal Blue Cross/Shield and then by TriCare Prime. It turns out that Fed BC/BS does not give pre-approval for bariatric surgery. You get it done and then they will decide if they will pay or not! I guess that slows down a few that are not that committed to it. All of my pre-op tests are scheduled and I have an appointment next Friday to find out if TriCare will cover it (or the remander) depending on what BC/BS does. Not too sure how that works with military insurance and the civilian world of medicine? I want my band either way but it would be such a load off to know I don't have to foot the whole bill! My hubby says not to worry about it... maybe he has plans to pay for it? Well good luck to everyone on this joint adventure- I don't see anyone else with my same date yet. I'd love a lapband buddy! Let's keep in touch!

I am getting Lap Banded by Dr. Halmi in Virginia on February 9th and I have Federal Blue Cross and Blue Sheild and they approved it and I have the letter. I called BC/BS and asked even before I had my first consult with my surgeon and they said it was covered, however, not until January 1, 2007. I had my pre-operative appointment today so if there was an insurance issue they would have told me. You might want to check with them again, because I have BC/BS Athem, Federal Government, yours should be the EXACT same thing. You might have someone at BC/BS who isn't up to date on the coverage changes. Hope this helps. Jacquie

Thanks Jacquie- My Federal BC/BS is called Regence since I'm in Washington State. They too are covering lapband as of 2007. I plan to call them myself on this but I was told this from not only from the insurance gal in the Dr.s office but by another local WLS patient (she had RNY and it took over 2 months post surgery for bc/bs approve). It seems odd that they would not provide pre-approval but I figure a lot of folks will be scared off and BC/BS won't have to pay it. The gal in the office says that they have a good track record of approving the bypass afterwards, but since they just started to cover lapband she has no data to call upon. I also have TriCare Prime (retired military) thru my hubby as my secondary insurance. I have to meet with them on Friday. Since they have me assigned to a civilian doctor (the one *****ferred me to wls) I'm hoping they will allow me to use a civilian surgeon as well. Best case senario- BC/BS pays 80% and Tricare picks up the rest, second best- I have to go to Madigan (Air Farce Base) and TriCare pays, Worst case senario- I go thru it as scheduled neither BC/BS or TriCare pay, I'll get thin, healthy and seriously in debt! I'd love to keep in touch to see how yours works out for you!

Hey, sure I'd love to keep in touch. Since I work for the federal government in claims, I like to hold the insurance companies feet to the fire. So, when BCBS starts hedging about paying I get really suspcious really fast. Most of the time it's a training issue. So anyway, I am glad to be getting surgery. I will be doing my pre-op testing on January 23, and my sleep study this week. Then I will be good to go in. People ask me if I am scared and all I say it I can't wait. I've been looking for help for 20 years and finally, I am going to get help. If I could have the surgery today I would. I didn't want the RNY because I was too afraid of the "cut and paste" routine where I would be permanently re-routed even thought the weight loss is faster. I like that the band is removable if anything happens or goes wrong. I can't wait to get into all my smaller sizes I have kept all these years. And hey, it's all back in style! Here's to the new you and the new me.

Geez- maybe I should have you call my insurance in a "Professional" capacity! I haven't been scheduled for a sleep study- That's one thing I thought they would want and I think I could use it. My hubby says I've started to snore like a chainsaw, I wake myself up and have awful night sweats when I'm on my back. I had my Ultra Sound, Chest X-ray, Cardio/Pulminary, urine and bloodwork done yesterday- you should see my arms! I'm a tough stick normally but since I hadn't been able to eat or drink since the night before my veins were non-existant! I have 4 at the bend, 1 in the forearm and finally 1 in the back of the hand- all are bruised... I look like a junkie! Tomorrow is my endoscopy- my Dr. insists on doing those himself. Friday I meet with a TriCare surgeon- from what the gal at the hospital said Tricare was acting like they are my primary and said they weren't going to pay for my tests since they hadn't given their approval get. When I told her they are the secondary she said it wasn't a problem them since they would pay what ever BC/BS doesn't. I hope that is also true of the surgery! I have a few smaller sizes but since I haven't been my ideal size since I was in Jr. High I'll be doing some shopping down the road. I've always been a catalog reader and most of the cute stuff hasn't been in my size. I looked thru one the other night specifically looking at the sizes... OMG I would just love to order a Medium anything!

Hey how you doing? Have been so busy haven't had a chance to respond. I had my sleep study and got woken up by the guy sawing wood in the next room then it took forever for me to sleep but they told me I had "severe" sleep apnea so I go back this weekend for the mask thing. What fun. Ok, if it helps me I'll do it. I will be getting all the lab stuff, an upper GI and other fun stuff January 23rd. After that, well my last pre-op appointment then next week my date. Somethimes when you drink some serious water the night before (they usually ask you not to eat or drink after midnight) so then your veins don't have a fit when you get stuck because you got some blood volume. So I will drink the night before, and I hopefully won't have the problem you had. I have been dreaming of smaller sizes too. Heck, I'd like to get into my smaller fat clothes. I won't need to buy anything until oh, about size 18. So I won't be shopping too much. However, I did go to Catherines Plus Size store because I needed new pj's to wear to the sleep study ; mine are all long T-shirts. Anyway the girl at the counter ask me if I wanted to open a credit card or rewards card with them and I said, "No way! I'm getting surgery next month and I hope to never have to buy clothes here again! Not that you all aren't nice ladies and all! No Thanks." To be able to have at least some reasonable expectation of buying non-plus size clothes for REAL? PRICELESS!

My endo went fine, I have my follow up with him on Monday but the papers that came home with me said he found Esophogitis, Gastritis, Hiatal Hernia and he also removed some polyps while he was in my stomach. I'm wondering if part of the reason he performs his own scopes is he tends to "find" a lot of Hiatal Hernias. That and GERD could be an opportunity to operate regardless of WLS. Could help the insurance coverage... "We needed to go in anyway". I survived my psych eval and nutrition class- turns out I'm not crazy afterall! Found out my Doc is as hard a$$ when it comes to his rules. I've been told to start the vitamin regimen and to begin "protein loading" adding 2 shakes to my normal daily intake. That's kind of good, I'll know how to make a great shake by the time it counts. I will have 2 weeks of clear liquid + shakes pre-op and 4 weeks post op! Then it's 2 more weeks of mushies. By then I'll probably receive a fill and have to start liquids again. No wonder his patients are so successful- he never lets them eat anything solid! I had a consult with the military docs and they would be more than happy to perform bypass on me- the doc was very blatant in his disregard of the band. He also didn't think Tricare would cover surgery off base. One of the nurse coordinators called me afterwards and gave some numbers to call about referrals to help cover it thru my Dr. She wasn't sure but thought it was possible and to call monday. It wasn't a total waste of time- they sent me a letter stating I wasan excelent candidate for WLS. I can always use that if I have to appeal a denial from BC/BS later. Take care and stay in touch- Stacey