WAITING IS IT APPROVED OR NOT?

Hello I am new here also on 10/30/06 I willhave an appt with the dr that does lap banding. I went to the seminar which is needed to understand this lap banding. And I filled all the papers his office sent me and I do have hmoil and they did give me a referral to contact the Dr. I have been doing paper work since May of 2006. To get this done. So now I need to wait . But the thing I don't understand is if the my insurance co approved it, or on this first visit is it up to the dr who is going to do the lap band so say yes he thinks I should have it done. I guess I won't know until I go to see him on the 30th. I am just so confused I don't want to get my hopes up and then let down.

You need to wait until you have your appointment and the doctor will THEN send in a letter explaining why you need to be considered for your surgery. They just do not arbitrarily send in your paperwork for approval before you have your appointment. What if you never show up for your appointment or you are not a candidate for a particular surgery? Then that doctor's office has wasted their resources for nothing.

Thank you for answering my message. Here is what I am confused I went to my Primary Dr in May 2006. She said I would need a referral to see if they would approve it first I have HMO IF ILLINOIS BC BS. She said it would take 2 weeks to see if would approve it.. Well I did get a letter from the Provider Netwok asking for clinical documentions for the ways I tried to lose weight. My Primary Dr also received the same lettter about the same request. My primary Dr did ask me to get prove of all the things I did to try to lose weight. Well I did and fax copies to my Primary Dr. she then wrote a letter to the Provider Network explaining all the ways I tried to lose weight. Well when she submitted all my paper work and the letter. I did receive a referral for an office visit to the Dr who does the lap band. Now when I called the Dr to set an appt. His office asked me to fill out some papers and go to a seminar about the lap band. Well they said they could not give me an appt until the insurance approves, They want some kind of committment from my insurance co on this surgery. So now the Dr office said I can go see the Dr on the 30th of this month. At the seminar I told the Dr that I have a referral I filled out his package of papers he sent me and been to his seminar he told I needed to make an appt to see him. So my question is am I approved because they would not make an appt if the insurance did not approve it right. I guess I don't want to get excited and then have a big let down.

I am not real familiar with HMO insurance but from what you are saying is that it sounds like what the doctor is supposed to be asking from the insurance company with his coorespondence is a predetermination of qualifying for surgery. I do not believe that they would be asking for approval at this point. It also sounds like the surgeon's office person used some wrong terminology when she said "they could not give you an appointment until the insurance approves". What you received from your primary doctor's office is a referral also to see another specialist as is necessary with an HMO. I would suggest that you post your question on the insurance forum on this sight. I am sure there are more people out there with your insurance that can answer your question. Give your insurance company a call and ask if they received all the paperwork and where you are at in the process with the insurance. Chris

Thanks chris I appreciate your responses. I willl let you know what happen on the oct 30th. I just keep praying that I am cleared to get this done. I know I have to have patience. I will keep in touch . Again thanks chris have a good day

I would check your BCBS HMO plan very carefully about what it's requirements are. I have BCBS PPO of IL. I have been "in the system" so to speak since January of '05, and my paperwork was all formerly submitted (after doing all that they required first) in March of '06. I was declined, and have been in the appeals process ever since. Hopefully for your sake the HMO is not as difficult. Do find out what they require though before you submit, or you will just be disappointed. Good luck to you!

Hi Charlotte ... congrats on your decision. As you get more familiar with the boards, you'll notice that there are a lot of hoops the insurance companies like to make people run through. Sometimes it can be a long, drawn out process. I wish I could offer more advice! Which doctor are you going with? Anyway, hang in there, the wait is definitely worth it! Karyn

Thank You for your response ! I know I have been dealing with paper work since May 2006. The Dr I will be seeing is at Rush University Surgeons and his name is Dr Jonathan Meyer or Meyers. Does anybody know anything about him. They said he is very good at what he does. Lap band.

Well Monday I go see Dr Meyers for the first time. I am nevous, but excited I don't want to get my hopes up and then be let down. I just keep wondering what will be the next step after the visit with him. Do I have to sit and wait ! what I am waiting for after that? Approval from the insurance company? how long does this take ? I am just playing a waiting game it feels like, I just want to get the ball rolling, I don't want the red tape anymore. But I will just have to wait, I have no choice at this point. I guess I am just so so ready for this. There is not a day I don't think or I can't wait for this to happen to me. I have a plan how to go in this new phase of my life so it won't be such a big notice. I want to do it gradually while I am losing the weight. I want to get a nice pretty hair cut and do my highlights again. I want to get new glasses the new modern ones. ( I wear wire ones now). Karyn B the doctor I will be seeing is Dr Jonthan Meyers at the Rush Medical Ctr. I just hope everything works out for me. I am so depress and I can feel myself getting more depress over this. PLEASE SAY A PRAYER FOR ME, I WON'T HAVE TO WAIT LONG TO GET THIS DONE.

Charlotte, Don't get discouraged my husband has been trying to get approved by Personal Care PPO of Illinois since Feb. We finally got the approval last week. I had to write several appeals letter. In each letter I wrote how he had complied. In my last letter I had to put an attorney's office on there and our state senator. I hope that you don't have to go through all of that but if you do please don't hesitate to get in touch with me. Good Luck!!!