New to site - would like information

Hi All. well, I tried this note once and I guess it didn't work, so I'll try it again..lol I'm new to the website as of today and I've read so much helpful information. I've recently started looking into Gastric Bypass. A friend of mine from work had it done by Dr. Fang and she looks wonderful. I guess I'm really not sure how I'm suppose to looking this whole thing. I went to a new family doctor this past week. I spoke to her about having the surgery. She seems to be ok looking into for me. She did want bloodtest and a Xray first before she proceeds I think. So, with that done, I guess I wait for the results. I'm still going back and forth to whether it's something I really want to proceed with. It's such a scary thing and such a life changing experience. I've battled with weight most of my life. I've always had to fight to keep at 200 lbs. but since i'm way over that now, I'm looking into this. Has anyone had Aetna Insurance and gone through this? Any insite would be great. I've been told you have a 6 month waiting period with Aetna, with follow ups to the doctor so show you've been trying to loose weight. I'm not sure if I should look into going to a free seminar to look into it further or is this something that would be set up for you... I guess I feel alittle unsure of so many things right now and would appreciate anyones thoughts that they would like to share. I'll also post my email just incase I don't get back here for awhile. I've enjoyed reading what i've come across so far. It's been very helpful. Thanks for the help and info. Lisa - [email protected]

Hi Lisa....Welcome! Your first month with an official weigh-in should have counted when you went to your primary care doc....She will need to keep detailed chart notes on your weight loss attempt and will need to council your for the 6 months diet attempt. Do NOT miss one of the months or you will have to start over. Aetna is very particular about that! I would suggest: 1.. Decide on the type of Weight Loss Surgery you think will work best for YOU!...You can read about the different types by going to the O.H. main paige. MOve your curser to Forums and then to "types of surgeries".....There are links to study up. 2.. Make an appointment to attend 2 to 3 different seminars with surgeons who accept Aetna and who may have been recommended by friends or people on this support site. 3. After you decide on a surgeon/program, then their Bariatric Coordinator will walk you through the remaining requirements to get your surgery approval. This will include, a pysch evaluation, medical records for 3 to 5 years, current physical, and depending on your health conditions, it may require an EKG with evaluation, Cardiac clearance, etc. It sounds like a lot but just make yourself a big checklist and start tackling it. You'll be fine!!!! In the meantime, just hang with us and ask your questions and do oodles and oodles of research!!!! It's a big decision but it opens up possibilities for an incredible future! Hugggz, Joyce

Hi Lisa, Welcome Im Aetna ins! First call to make sure YOUR plan pays for Gastric Bypass surgery. some do and some dont. They have a very small list of Drs that they approve for this surgery. I dont think they will pay for the Band..Mine didnt. Im partial to the Gastric Bypass, I know people who have had the band...to me..not as effective. Too many ways to get around that band. Seems patients wont lose all the weight they need to with the band. Dr Fang and Juarez are approved by Aetna. They work thru St Lukes hospital in phoenix. Call the Bridges center for weight loss at st Lukes Hosp and they will send you a Info pack. Aetna will pay only if you have a 6 month diet and exercise program with your Primary Care Dr. With Aetna you must have a BMI over 40 or BMI over 38 with 2 Co morbidities. I started my journey last August and had My Surgery June 9 2006. Im 1.5 weeks post op and feel great. Im going back to work today. No lifting over 20 lbs for a few more weeks but thats ok..means NO VACUMING Good luck and have a fun journey. Sally

Just adding my two cents.....Aetna absolutely DOES pay for Lap Band surgery and though we are all convinced that our personal choice for surgery is the best thing that ever happened to us and therefore should solve EVERYONE"S personal weight loss issues as well,.....the Lap Band is the best thing for SOME people. .... I had my surgery with the Bridges folks as well and absolutely love their comprehensive program BUT....there are many amazing places to choose from as Arizonans on the hunt! Don't let Aetna's requirements discourage you! Go for it! Huggggz, Joyce

Hi! I am new to the site also. I am actually going to my first consultation this Thursday, with the group at Scottsdale Healthcare with Dr. Blackstone. The patient liasion said I have good insurance and so far I only have to pay a portion of my $1000 consultation fee. Is that a good thing? is a sign of approvals? (I hope!) :) I also went to my PCP to get my letter of medical neccessity and she told me that since I have a PPO that I don't need a referral and some of the other necessary paperwork, but I do not have alot of comorbidities (just back and knee problems & asthma which I have had all my life). I am just confused by everything really... so I have a few questions. So many people at my job have had the surgery, so I hope that that is a good thing! How many appointments and what kind of tests will occur prior to the surgery? Is there alot of out of pocket cost for these? Or once you are approved for the surgery will it be covered? How long does approval take on average? Does that occur after the first initial consultation? What is the psychological test? Thanks so much! Sorry if this is alot of questions.... I am sure I will have alot more! Nicole

Hi Nicole, I'm hearing that money may be an issues (isn't it always???!!!!) .......and though I know Dr. Blackstone is a great doc.....just know that there are options in the valley that do NOT cost an extra $1,000.00 out of your pocket PLUS your insurance deductable and/or hospital co-pay. Bridges does not have any program fee and does have a comprehensive program with support groups run by psychs.....and the surgeons are incredible!......If you are after Lap Band then Dr. Simpson has one of the lowest program fees and has a higher nubmer of exclusve lap bands than anyone..... and is the only surgeon I've ever heard of that actually responds to personal e-mails to patients. .... There are others who may not charge a program fee (aka as consultation fee, aftercare program fee, etc.) but may not have support groups, lifetime nutrition counseling, etc. It is very confusing when you are in the hunting stage. I would suggest that you see who your pcp recommends and who takes your insurance and then study the O.H. site on the different types of surgeries so you can select one that works best for YOU. .... I also suggest attending more than one FREE seminar since every surgeon is a little different. If you ask most people about the best surgeon, they will undoubtedly tell you the name of their surgeon.......that's a good thing cuz they got the pkg they were hoping for....just study study study and then know that the Bariatric Coordinator of each program will help walk you through the insurance hoops. At our office....the course of events is usually-- 1. Free SEminar 2. Consulation with Doctor and meeting with Bariatric Coordinator 3. Get psych evaluation..... and, depending on who you are insured with, you may also need..... Letter of medical necessity from your pcp current physical 3 to 5 years of medical records showing a history of obesity 1 to 3 co-morbidiities if your BMI is under 40 (this could be diabetes, high blood pressure, GERD, sleep apnea, high cholesterold, etc) 6 month supervised diet with your primary care physician (must turn in detailed chart notes) If over 50, then most require an EKG and a cardiac clearance. If, all you need is steps 1 through 3, then we submit to insurance and within 2 to 4 weeks (sometimes sooner) you will get your approval and then a surgery date. After the surgery date, you will need to attend required nutritional and pre-op teaching days. Hope that helps! good luck....it's an exciting adventure! Joyce

Thanks Ladies for the information. It has been very helpful. I actually got a call today from my doctor's office and said I was approved for 3 visits to Dr. Fangs office. So, I called and got a seminar set up for the end of July at Bridges and another appointment set up for a consultation at Dr. Fangs office. Darn vacations get in the way of stuff don't they..lol My question is... Is this approval just to get things going and see what happens along the way? My doctor said she is sending me info. on a nutritionalist and other people to see. So, I'm guessing I have to get past these people first before it goes any further? lol I'm still alittle anxious about the whole thing, but I guess it's a learning process. I told my friend at work who had it done, and I think she was more excited than I was..lol I think I'm just really nervous about the whole thing and I can't tell you how much this has helped :) It's a nice feeling to be able to come out here and see what other people are going through. I'm usually not on the computer at home too much but boyfriend left last week and is gone for 4 months and I have a dog and a pregnant stray cat to take care of. It' actually nice to be able to come out here and get an uplifting feeling when I leave. Glad I had the time yesterday to find the site! Lisa

Lisa, It sounds like you recdived an insurance authorization to go out of network? ....Once you have completed Dr. Fang's requirements (which is probably just a psych evaluation with Dr. Maxwell) then they will submit to your insurance. The pre-authorization from your insurance will allow Dr Fang's office to actually schedule the surgery! Since you're filling time without your honey bunches at home....here are some other fun sites to read through.... www.vitalady.com www.bariatriceating.com (Susan Maria has a free message board too) www.livingafterwls.com So, what kind of kitties will you be having? Joyce

Hi Joyce, thanks for the sites. I'll have to look into them this weekend. As for the kittens, I'm really not sure..lol There seems to be a few Black Cats around the neighborhood, so I'm sure one of them is the dad. She is Black and white herself. She is my little distraction for the moment. I leave for Vermont next week, so I'm hoping she has them before I leave. Since she seems to have been an outside cat for quite awhile, I'm trying to get her use to my house so she won't be out in the heat or have something happen to her. I don't want her having kittens and I don't know where she is... I see you work in a Doctor's office so can I ask a general question? When I went to my family doctor to talk to her about the surgery, she had asked if I had seen a nutritionalist and I told her no. When her office called with authorization the other day to Dr. Fangs office, she mentioned I would have paperwork to see one. I received a script in the mail today to see a nutritionalist, so I'm not sure if this is something she wants or part of the steps to have this done. I called and scheduled an appointment for Bridges and Dr. Fangs office and both said they would send me stuff in the mail this week. I know I have to have my 6 appointments with my regular doctor, So i'm just hoping this nutritionalist is part of the steps and nothing she wants. I don't want her to NOT help me along the way if it is something I need to do on my own. I think she might be a little leary of people having the procedure if they haven't used all their options up first. I hope that makes sense :)

Lisa, Your insurance probably requires the nutritionist visits. You will most likely use Janel at Bridges (St Lukes) as your nutritionist. She is wonderful! Tell her hello from me! ......It sounds like you are on your way to the finish line! Yay! ...Have fun in Vermont and best wishes to the kitties! Joyce