Help!! Need Insurance Info

Hello to everyone! I have been checking out all the wonderful information on this site for the past week. I am so glad I found it! I have my first visit with Dr. Steven Clark tomorrow to talk about the Lap Band procedure. I have gathered all my medical records for the past 2 years since that is when I first developed Diabetes Type II and High Blood Pressure. (guess I got my father's health genes!) I have been taking meds since and I am definently ready for a change. My insurance is Sagamore American and they told the doctors office they would pay a certain amount towards the surgery if it was medically necessary. Does anyone else out there have the same insurance and if so how long did it take to get approved? Do I need to be on some type of doctor supervised diet for several months before they will approve it? I thought that was a bit ridiculous since that's what I have already done off/on for the past 20 years. My doctor has kept good records on my weight and attempts at loosing it for the past 2 years. I have also been going to Weigh****chers since last September and lost around 20 lbs.

Hello. I also have Sagamore and have talked to them a lot about what is covered. Please make sure that every diet attempt or comorbidity is documented with your dr. and with you. They told me that as long as it was medically necessary and you meet their criteria, which was having comorbs, documentation of history and at least 100 lbs. over weight then they will take it into consideration. When I heard the last part I thought, gee how nice it is for you to take my life into consideration. That's like telling me that they get to choose to help me get healthier or die. Maybe I just read too much into it. But other than that I feel confident that they will pay if you meet their criteria. But I am in the beginning stage so that's all I have to offer right now. Good luck in your journey... Barb

Thanks Barb. I have documentation for the last 2 years from my doctor on when I was diagnosed with Type 2 and BP problems. The doctor doesn't have any diet attempts except for one logged anywhere in my records. Do you think that will be enough? I wonder how long it takes them to make a decision. Have a good day, Regina

This comment I"m making has nothing to d with your insurance.... I just needed to say - DR CLARK - YEAH!!!! LAP BAND - YEAH!!! That is all. Sorry for the interruption.

Thanks Jodi! That is very encouraging! I will keep you posted on what I find out today. If I mention your name do you suppose I could get a discount??? (LOL) Regina

Amy in Dr Clark's office helped with my insurance paperwork (Sagamore Plus). She was able to use the fact that I had been on a Diabetes meal plan for a year to meet the doctor's supervised diet criteria. As long as your PCP documents that he/she has monitored your diabetes, including diet, you should be good. It only took about a month from the date of the first letter (plus numerous phone calls to keep me on their minds!) to get my approval. I'm scheduled for April 7th, Lap RNY. Good luck Cindy

Thanks Cindy! I have to make an appointment for a psych evaluation so I'm hoping I can get that in really soon. I talked with Amy and she was really helpful. I had originally went there thinking that I wanted the Lap Band and now I think I'm leaning more towards the RNY procedure because I definently don't want to keep taking insulin shots for the rest of my life and Dr. Clark said the results of the RNY were more successful in treating those with diabetes better. I will keep you posted! Regina