Newbie here! How do I start?

Ok, so this may seem like a dumb question to some of you but how do I get started? I've researched for two years now, and I have finally decided that the Lap Band procedure is right for me. I know that my PCP is anti-WLS. I've discussed WLS with him before. He doesn't even believe in prescription weightloss medications. My insurance is Cigna Open Access Plus. I technically don't even have to have a PCP. Can I ignore my PCP and bypass him altogher? Do I start with the Insurance Company or with a Surgeon? I am going to Dr. Oh's seminar in Washington next week. (I like his very thorough after care program. He's pretty strict.) Right now, I'm still looking into surgeons. I'm not to fond of Legacy Emanual. (#1 Legacy is ALWAYS out of network and they seem a little upity about their surgery process). Another set of questions: I just had gallbladder surgery in March, do I have to do the Upper GI again? Yuck, I hate that one. :-P Also since, I have sleep apnea and use a CPAP, I'm assuming I don't have to do another sleep study??? PS. I'm so happy I found a message board with folks from Oregon!

Hi Mona, I had my surgery through Kaiser in California, so I don't have any advice for you. I just wanted to say "hi" and wish you luck in this rollercoaster journey. Hopefully, after the holiday, folks will start posting more and you'll get some advice that will help you. Welcome to our forum! Joy

Hi Mona, I had the Lapband surgery last Sept. by Dr. Tersigni in North Bend/ Coos bay He has a great 1 year follow up plan. his cost then was $12,500. My insurance didn't cover any WLS. So I paid out of pocket. First check with your insurance company to see if they pay on lapband. It seems like alot of ins. out here don't cover. They cover it more on the east coast. If you have any questions feel free to e-mail.Marilyn

Issue #1: If you aren't going through your insurance company, a PCP isn't necessary. HOWEVER, your medical "life" is best supported by someone who supports you. You will encounter questions/issues that aren't surgery related but need to have a doctor who is at least familiar with the surgery to recommend treatment. Case in point -- antibiotics. If you get sick and need to take antibiotics, your doctor must prescribe drugs that are small enought to fit through the new stoma. Antibiotics can be HUGE. I'd be concerned that, if your doctor doesn't support WLS, what type of support will he be able to provide to you in general? You have the right to disagree with him but you will also need his support at some point in the future. I'd suggest you try to find another PCP that is supportive of surgery. Issue #2: What's the matter with Legacy? They were great to me and their aftercare is really great, too. I'm assuming you mean Oregon Weight Loss Surgery out of Good Sam, not Emanuel? Dr. Emma Patterson is the primary doc, with Drs. Hong and Jan supporting her in surgery? My surgeon was Dr. Jan. He has been nothing less than fabulous. I'm not saying they're the best or only choice, I just don't want you to completely rule them out, either. They are pretty spendy, though (as is OHSU). Issue #3: Upper GI -- depends on your doctor and the surgery you have. I didn't need one at Legacy. Issue #4: Sleep apnea -- the test usually has to be less than a year old for them to be able to consider it. If its older than a year, you may not need to actually have another sleep study but you may need to have a conversation with a sleep specialist who will make the determination on how well the CPAP machine is working for you. Issue #5: Enjoy the ride. It can be so terribly emotional. Good luck to you! Lori

Hi Mona, Good luck! It is a big moment to think to yourself "I'm going to do it". It is a truly wonderful direction to take yourself in. I love your picture of you and your son. It is extra scary as a mom to worry about doing a procedure, but the payoff will be so great for all in the family. I figure the best place to start is by getting a very specific reading from your insurance rep as to what your policy covers in relation to bariatric surgery. What will the reqiurements be for approval, how is that approval obtained, what is the expected time approval from submittal date to decision, etc. If they require a time period of weight loss efforts that are documented, start putting together any records you already have (including those visits where you discussed it with your PCP) and if you don't have any, start now. Some require six months worth, and if you start now that time will be here before you know it. Next, I would change PCPs. You need to have one that is supportive of going forward with this surgery and that is willing to help in pre-testing and follow-up care in coordination with your surgeon. That is another clarification for your insurance. Mine continues to cover follow-up with my surgeon, but some only do for a certain amount of months. It might help to have a letter of recommendation from your PCP when you submit your package to the insurance for approval, so I think there are a lot of reasons to switch to a more supportive doctor. There are plenty of them out there. Most things like sleep studies, upper G.I.s, etc. can be used in relation to pre-approval testing if they are current. What current is depends on your surgeon and/or insurance approval board. I had my surgery thru Legacy Good Sam. I had great care, think their bariatric surgery program is tops, and loved my surgeon Dr. Hong. Good luck to you! Patty

Thank You all for your help! I called Cigna today. They cover vertical band, LapBand and RNY. Now I'm having a difficult time finding an in-network surgeon. Legacy is out-of-network. Dr. Tersigni in Coos Bay is out-of-network. Bariactric Clinic in Eugene is out-of-network. Corvallis is out-of-network. Anybody else have Cigna? Are your surgeons listed as gastroenterologists?