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Insurance Discuss insurance topics for the gastric bypass and Lap Band® operations.

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Old 02-11-2009, 03:12 PM   #1 (permalink)
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Exclamation Starting *Our* 6 Months!

Hey Everyone,
This thread is mainly to group all of us on the 6 month journey (medically, professionally, required by insurance diet) to help with obstacles that may occur. Please feel free to read the whole thread or just jump into the last page and introduce yourself!
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Old 02-13-2009, 01:20 PM   #2 (permalink)
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I officially start my 6 month physician supervised diet on Monday when I meet with my PCP. I really started it back in November though when I started this roller coaster ride.
We're gonna do this!!!! :-) 6 month diet, here we come!!!!!
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Old 02-13-2009, 01:27 PM   #3 (permalink)
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Originally Posted by CKJCreations View Post
I officially start my 6 month physician supervised diet on Monday when I meet with my PCP. I really started it back in November though when I started this roller coaster ride.
We're gonna do this!!!! :-) 6 month diet, here we come!!!!!

OOo my goodness thank goodness there is someone here. Since my first PCP visit on 02/11/09 and my weigh in today I am down 5 lbs. Thank goodness for water weight! That is just by not drinking pop & my star bucks in the morning!
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02/12/09 WLS Journey Starts!
03/23/09 Submit to BCBSofMI
04/21/09 Officially Approved
05/27/09 PreOp Testing 05/29/09 OpenRny Surge Date!
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Old 02-13-2009, 07:47 PM   #4 (permalink)
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OOo my goodness thank goodness there is someone here. Since my first PCP visit on 02/11/09 and my weigh in today I am down 5 lbs. Thank goodness for water weight! That is just by not drinking pop & my star bucks in the morning!
Hi and Welcome! I am just starting too. I was able to talk my PCP into writing me a note saying I had lost 9 lbs since October 2007 in anticipation of weight loss surgery (I had lost 9 lbs but, like you, this visit was in the morning, fasting, with less clothes, etc. so it was probably more like 6!) So I'm hoping I don't really have to do 6 more months! My surgery doc just asked me to lose another 10 lb.s before surgery. I have been on a diabetes diet for a couple weeks now anyway so that should be no problem! (If i can stick it out!)

Have you decided which surgery you are going to have?

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June Staplers OCTOBER Challenge: Continue to walk or do other exercise at least 4 days a week for one hour!

Surgery Date: June 18, 2009

232/202/160/130
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No longer obese = 163 (met goal: 9/27/09)
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Old 02-14-2009, 03:52 PM   #5 (permalink)
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Originally Posted by NikkiJoT View Post
Hi and Welcome! I am just starting too. I was able to talk my PCP into writing me a note saying I had lost 9 lbs since October 2007 in anticipation of weight loss surgery (I had lost 9 lbs but, like you, this visit was in the morning, fasting, with less clothes, etc. so it was probably more like 6!) So I'm hoping I don't really have to do 6 more months! My surgery doc just asked me to lose another 10 lb.s before surgery. I have been on a diabetes diet for a couple weeks now anyway so that should be no problem! (If i can stick it out!)

Have you decided which surgery you are going to have?


oOoo oyou must have a great PCP! I had an awful time with the first PCP. And so I went PCP shopping and found someone I think is truly going to help. I really want the Laparoscopic Gastric Bypass Surgery what about you?
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02/12/09 WLS Journey Starts!
03/23/09 Submit to BCBSofMI
04/21/09 Officially Approved
05/27/09 PreOp Testing 05/29/09 OpenRny Surge Date!
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Old 02-14-2009, 04:52 PM   #6 (permalink)
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Originally Posted by Sparkles View Post

oOoo oyou must have a great PCP! I had an awful time with the first PCP. And so I went PCP shopping and found someone I think is truly going to help. I really want the Laparoscopic Gastric Bypass Surgery what about you?
Yes, my PCP is very supportive and helpful. Some of his family had the surgery so he's familiar with it. I'm glad you found someone who will be supportive!

I was told by the WLS doc that I should get the bypass as well because I have diabetes. Not sure why, but that is the one I am leaning toward now...

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~Nikki~

June Staplers OCTOBER Challenge: Continue to walk or do other exercise at least 4 days a week for one hour!

Surgery Date: June 18, 2009

232/202/160/130
Highest/Surgery/Current/My Goal

Other goals:
No longer obese = 163 (met goal: 9/27/09)
No longer overweight = 135
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Old 02-16-2009, 10:04 AM   #7 (permalink)
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Yes, my PCP is very supportive and helpful. Some of his family had the surgery so he's familiar with it. I'm glad you found someone who will be supportive!

I was told by the WLS doc that I should get the bypass as well because I have diabetes. Not sure why, but that is the one I am leaning toward now...


Nice! I love how colorful your siggy is. Are you personal pay or what kind of insurance are you on?
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02/12/09 WLS Journey Starts!
03/23/09 Submit to BCBSofMI
04/21/09 Officially Approved
05/27/09 PreOp Testing 05/29/09 OpenRny Surge Date!
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Old 02-16-2009, 11:33 AM   #8 (permalink)
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Nice! I love how colorful your siggy is. Are you personal pay or what kind of insurance are you on?
I have Pacificare Insurance, but because I belong to the Sharp Medical Group, all my authorizations go through Sharp and my insurance only gets involved if there is a dispute. My surgery doc said this is much better as they are a lot easier to deal with than the insurance company, so I hope that holds true for me!! So far I've had to pay copay's out of pocket ($10 for PCP and $30 for surgeon) and I should only have to pay $100 a day for the hospital stay, so I should be getting by fairly cheap!

How about you??

PS...I'm running out of good colors to add in my siggy, so I hope I don't have a lot of other appointments to list!!

__________________

~Nikki~

June Staplers OCTOBER Challenge: Continue to walk or do other exercise at least 4 days a week for one hour!

Surgery Date: June 18, 2009

232/202/160/130
Highest/Surgery/Current/My Goal

Other goals:
No longer obese = 163 (met goal: 9/27/09)
No longer overweight = 135
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Old 02-16-2009, 11:40 AM   #9 (permalink)
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Quote:
Originally Posted by NikkiJoT View Post
I have Pacificare Insurance, but because I belong to the Sharp Medical Group, all my authorizations go through Sharp and my insurance only gets involved if there is a dispute. My surgery doc said this is much better as they are a lot easier to deal with than the insurance company, so I hope that holds true for me!! So far I've had to pay copay's out of pocket ($10 for PCP and $30 for surgeon) and I should only have to pay $100 a day for the hospital stay, so I should be getting by fairly cheap!

How about you??

PS...I'm running out of good colors to add in my siggy, so I hope I don't have a lot of other appointments to list!!


I am sure you can do a pattern of colors! LoL. Well that’s pretty good spending. Will your Surgeon Office submit after your 6 months is completed? What are all your little “hoops” you have to jump through?

From what I am told I have a 90% Covered by Insurance and 10% Out of Pocket with a maximum out of pocket of $500.00. But I do have to pay for $10.00 PCP/Surgeon Visits. I have to pay 50% of the Nut Doc visit (Like $100.00 total). So less than a thousand for sure is what the Benefits Customer Service Rep said. We will see. Oh plus I am on WW for the 6 months with a PCP visit each month. Unless they will accept the last WW attempts I have had but I won’t know until 04/14 Surgeon consultation.

Whats your motivation?
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(`'•.¸(`(`'•.¸ (`'•.¸¸.•'´)Nichole(`'•.¸¸.•'´) ¸.•'´) ´)¸.•'´)
02/12/09 WLS Journey Starts!
03/23/09 Submit to BCBSofMI
04/21/09 Officially Approved
05/27/09 PreOp Testing 05/29/09 OpenRny Surge Date!
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Old 02-16-2009, 11:58 AM   #10 (permalink)
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Quote:
Originally Posted by Sparkles View Post

I am sure you can do a pattern of colors! LoL. Well that’s pretty good spending. Will your Surgeon Office submit after your 6 months is completed? What are all your little “hoops” you have to jump through?

From what I am told I have a 90% Covered by Insurance and 10% Out of Pocket with a maximum out of pocket of $500.00. But I do have to pay for $10.00 PCP/Surgeon Visits. I have to pay 50% of the Nut Doc visit (Like $100.00 total). So less than a thousand for sure is what the Benefits Customer Service Rep said. We will see. Oh plus I am on WW for the 6 months with a PCP visit each month. Unless they will accept the last WW attempts I have had but I won’t know until 04/14 Surgeon consultation.

Whats your motivation?

Yes, I guess I can start over with the colors...lol...good idea!!

I'm not sure exactly all the hoops I have to get through....so far there are mandatory seminars and the nutrition counsel and I've had to get all my tests up to date (mammogram, pelvic, EKG, Echo, etc.) and a lot of blood work. I am hoping I do not have to do 6 months diet since my PCP already submitted a statement of weight loss for me from Oct. 2007 until now. My GB doc asked me to lose 10 lbs before surgery. I have to shrink my liver and get my diabetes A1C level to 7.5 before surgery as well.

As far as motivation goes, i guess the main thing is just plain tired of being fat!! And now that my health is getting worse, it is just time to do something! My mom has just had the lapband done (Dec. 31) so she is also my motivation - well, we will motivate each other!! I have been doing really good on my diabetes diet and some days I think I can just do this on my own, but then I will smell something while driving and the urges just get to me, so in the long run I feel I will need more than just will power to get to my goals!!!!


__________________

~Nikki~

June Staplers OCTOBER Challenge: Continue to walk or do other exercise at least 4 days a week for one hour!

Surgery Date: June 18, 2009

232/202/160/130
Highest/Surgery/Current/My Goal

Other goals:
No longer obese = 163 (met goal: 9/27/09)
No longer overweight = 135
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