Littleroo27 Posted November 17, 2006 Report Share Posted November 17, 2006 I just had a meeting with my HR department about some sleep problems I've been having (I have delayed REM sleep). In the process of the discussion I mentioned my hope that having the lap-band surgery and losing weight would help with my sleep problems, but that I didn't know when I could get it done since it was self-pay. Well, my buddy Ruth, in HR, told me that we are switching to a new medical insurance on 01/01/07 (Cigna) and that their HMO program covers the lap-band! Of course, I have no idea what the diff is between HMO and PPO and will need to consider that, but still - they cover it!!! *bouncy* The only bummer is that now I won't be able to have Dr. Ortiz do the procedure . I mean, the surgeon I was going to go to first is experienced and does have a very low complication rate, but it's still not what Dr. Ortiz has. Ah, for ten thousand dollars... Do you know what the cost is for OCC to do fluro fills on people who got their surgery done elsewhere? As I understand it, Scripps La Jolla only does fluro on the first fill. Link to comment Share on other sites More sharing options...
mommyrkr Posted November 17, 2006 Report Share Posted November 17, 2006 Hey Littleroo!! That is so exciting. I would be bummed about no Dr. Ortiz too, but to save all that money.... Anyway, congradulations. Becki Link to comment Share on other sites More sharing options...
LoriBecky Posted November 18, 2006 Report Share Posted November 18, 2006 Hi Roo, Its $350 for non patients Link to comment Share on other sites More sharing options...
CalKev Posted November 18, 2006 Report Share Posted November 18, 2006 I just had a meeting with my HR department about some sleep problems I've been having (I have delayed REM sleep). In the process of the discussion I mentioned my hope that having the lap-band surgery and losing weight would help with my sleep problems, but that I didn't know when I could get it done since it was self-pay.Well, my buddy Ruth, in HR, told me that we are switching to a new medical insurance on 01/01/07 (Cigna) and that their HMO program covers the lap-band! Of course, I have no idea what the diff is between HMO and PPO and will need to consider that, but still - they cover it!!! *bouncy* The only bummer is that now I won't be able to have Dr. Ortiz do the procedure . I mean, the surgeon I was going to go to first is experienced and does have a very low complication rate, but it's still not what Dr. Ortiz has. Ah, for ten thousand dollars... Do you know what the cost is for OCC to do fluro fills on people who got their surgery done elsewhere? As I understand it, Scripps La Jolla only does fluro on the first fill. Littleroo, I can understand your quandary with being unable to have Dr. Ortiz as your doctor. You might still want to consult him if not for only for a referral as you already have been down to see him. Good luck - Happy for you - it is almost unheard of to have insurance cover the lapband. We all want to get healthy so do it anyway you can - as they say - You Go Girl. Kevin Link to comment Share on other sites More sharing options...
John R Posted December 11, 2006 Report Share Posted December 11, 2006 Littleroo, I can understand your quandary with being unable to have Dr. Ortiz as your doctor. You might still want to consult him if not for only for a referral as you already have been down to see him. Good luck - Happy for you - it is almost unheard of to have insurance cover the lapband. We all want to get healthy so do it anyway you can - as they say - You Go Girl. Kevin Kevin, I am brand new to the forum. I am schedualed to have my surgury Jan 8th. I am in the midst of having it approved by BC/BS To you think I will have difficulties.I have found this site to be very helpful and informative. So thanks everyone for being so supportive. Link to comment Share on other sites More sharing options...
CalKev Posted December 11, 2006 Report Share Posted December 11, 2006 Kevin, I am brand new to the forum. I am schedualed to have my surgury Jan 8th. I am in the midst of having it approved by BC/BS To you think I will have difficulties.I have found this site to be very helpful and informative. So thanks everyone for being so supportive. John R. - Congratulations on your pending surgery! We will all be crossing our fingers you will get the clearance from your insurance asap. Keep us updated! You are right the Bandsters here are awesome... all of them. I look at it this way all those here that are banded or planning to be banded or believe in banding as a tool for healthy living are Banisters. We all want to be better healthier people and see that the band is a means to the lifestyle we crave. I am with you this site offers what others can't... It's hasn't been polluted with dishonest people. Dishonest as in members that can't be real with themselves. The bandsters here are real people and not afraid to expose their true feelings online to help themselves and others that visit the forum. Good stuff.... Thank you for joining in and letting everyone know about your personal journey. Best wishes! Kevin Link to comment Share on other sites More sharing options...
barbflorida Posted December 19, 2006 Report Share Posted December 19, 2006 Wow! How lucky to have your insurance pay. I have Florida Health Care and I think they are the last to approve anything new, so if I waited for them I'd probably be 80 years old before they would pay for it. I even checked local doctors and found a few, but none with any real experience and they charged a LOT more, so I was really happy that I was able to go to Mexico. I was so impressed with everyone there, but if I could have saved that much money - I'd have had to give some serious thought to the experience issue. Good luck with your surgery, I know you're going to love it. Link to comment Share on other sites More sharing options...
Littleroo27 Posted December 19, 2006 Author Report Share Posted December 19, 2006 Well, the most experienced surgeon covered under CIGNA (in my covered HMO area) has done about 100 lap-bands. And, of course, that's a lot. But compared to Dr. Ortiz - it's NOT! I'm trying to get my insurance to consider adding some other doctors with more experience, as 90% of their covered surgeons specialize in gastric bypass / reux-en-y and not lap-band. *sigh* It's a process! Plus, I have to do 6 months of doctor supervised dieting first. Like I haven't been doing THAT off and on my whole life... Wow! How lucky to have your insurance pay. I have Florida Health Care and I think they are the last to approve anything new, so if I waited for them I'd probably be 80 years old before they would pay for it. I even checked local doctors and found a few, but none with any real experience and they charged a LOT more, so I was really happy that I was able to go to Mexico. I was so impressed with everyone there, but if I could have saved that much money - I'd have had to give some serious thought to the experience issue. Good luck with your surgery, I know you're going to love it. Link to comment Share on other sites More sharing options...
Marissa Posted December 26, 2006 Report Share Posted December 26, 2006 You all seem so happy with Dr. Ortiz, my insurance approved me right away (Oxford) it took them 4 days to aprove it and they are paying the entire $25,000USD if i decide to do the operation. But im a chicken and if I do decide to have surgery - I dont know if i should do lapband or just get the laproscopic bypass done - i mean if im goign to do it i should just go all the way right? well i dont know but im a chicken! a fat one! I just dont want to have the lapband done and then god forbid have to have another surgery to take it out! Any suggestions? Link to comment Share on other sites More sharing options...
ms883 Posted December 28, 2006 Report Share Posted December 28, 2006 You all seem so happy with Dr. Ortiz, my insurance approved me right away (Oxford) it took them 4 days to aprove it and they are paying the entire $25,000USD if i decide to do the operation. But im a chicken and if I do decide to have surgery - I dont know if i should do lapband or just get the laproscopic bypass done - i mean if im goign to do it i should just go all the way right? well i dont know but im a chicken! a fat one! I just dont want to have the lapband done and then god forbid have to have another surgery to take it out! Any suggestions? Consider this: a lapband is 100% reversable. If you decide that you do not like it, you can have it removed. If you go in for gastric bypass, and parts are snipped out, you can't get those back if you don't like the surgery. Food for thought (no pun intended! ) Ms883 Link to comment Share on other sites More sharing options...
Littleroo27 Posted December 29, 2006 Author Report Share Posted December 29, 2006 A lot of people are very happy with gastric bypass, so it's up to you, but be sure to consider all the options. Gastric Bypass has a lot more complications both directly after surgery and over the course of your life. You will lose the weight faster, but it won't help you feel more full, it will just make things go through you faster. And as someone with IBS, I can tell you that is NOT fun. Depending on your age you may have to go back in to get the lap-band replaced at some point. After all - it is plastic, and plastic degrades eventually. But I'd honestly rather do that then worry about having bits of my body removed and not being able to fix it later. You all seem so happy with Dr. Ortiz, my insurance approved me right away (Oxford) it took them 4 days to aprove it and they are paying the entire $25,000USD if i decide to do the operation. But im a chicken and if I do decide to have surgery - I dont know if i should do lapband or just get the laproscopic bypass done - i mean if im goign to do it i should just go all the way right? well i dont know but im a chicken! a fat one! I just dont want to have the lapband done and then god forbid have to have another surgery to take it out! Any suggestions? Link to comment Share on other sites More sharing options...
mommyrkr Posted December 30, 2006 Report Share Posted December 30, 2006 Marissa, We are in similar positions. My starting weight was 265, my goal is 150. I met with a friend the other night, she was home for Christmas. She had bypass two years and a few months ago. I hadn't seen her in a year. She initially lost 100 pounds. Now, she is up 25. She still is better, but she eats far less than I do, and is gaining weight....her body is adapting. She doesn't exercise, and does particularly eat healthy, but still looks and feels better. She has a huge scar all down her stomach and paid twice what I did for my band. It made me so glad to have done what I did. It was her courage in having surgery in the first place that really pushed me to look into it, but I'm glad I chose the band. I have very small scars, by husband has asked where the small ones were, he didn't see them, and it has only been 4 months. I have lost 40% of my body weight, not far from where my friend is now, but I am still losing, where she is gaining. If I was ever in her position, gaining, I know what to do. I would need another fill, where as she doesn't have any options, she already rerouted and permenantly rearranged her body. Lapband is the future of bariatric surgery. I am sure that 10 years down the road, you would be glad to have the lastest and best, instead of the most common. By the way, I am down 45 pounds, and haven't found my correct level of restricition yet. So more will be coming. But if I never lost another pound, I am happy, I have more energy...I can move and fit in clothes. I am almost out of plus sizes!!! I love my band. Becki Link to comment Share on other sites More sharing options...
EJ01111 Posted December 31, 2006 Report Share Posted December 31, 2006 Kevin,I am brand new to the forum. I am schedualed to have my surgury Jan 8th. I am in the midst of having it approved by BC/BS To you think I will have difficulties.I have found this site to be very helpful and informative. So thanks everyone for being so supportive. John R. - Congratulations on your pending surgery! We will all be crossing our fingers you will get the clearance from your insurance asap. Keep us updated! You are right the Bandsters here are awesome... all of them. I look at it this way all those here that are banded or planning to be banded or believe in banding as a tool for healthy living are Banisters. We all want to be better healthier people and see that the band is a means to the lifestyle we crave. I am with you this site offers what others can't... It's hasn't been polluted with dishonest people. Dishonest as in members that can't be real with themselves. The bandsters here are real people and not afraid to expose their true feelings online to help themselves and others that visit the forum. Good stuff.... Thank you for joining in and letting everyone know about your personal journey. Best wishes! Kevin Link to comment Share on other sites More sharing options...
EJ01111 Posted December 31, 2006 Report Share Posted December 31, 2006 Hi John R. My surgery was covered by my BC/BS. Although I did not have any serious health risks (eg. cardio, orthopedic, etc) I did qualify under the height/weight and BMI. I also did not have the blessing of my PCP and BC/BS approved it on the first request. BC/BS has become very proactive in helping their clients and issues of weight. All I had to do was write a check for the co-pay. Best of luck to you and if they say "No" first time, keep at 'em ! In the long run it is cost effective. EJ Link to comment Share on other sites More sharing options...
EJ01111 Posted December 31, 2006 Report Share Posted December 31, 2006 Littleroo - If your new insurance carrier does not cover Dr. Oritz (as he is not in their network ?) you might be able to get your PCP to request on your behalf that your surgery be covered out of network. You obviously have built a trust with Dr. Oritz and that means everything when one is having surgery. Although I am not a patient of Dr. Oritz, it is quite obvious to me he is held in high regard and is an experienced surgeon. You maybe be able to mention that as well that he has more experience etc.... Good luck but don't take "no" for an answer either. EJ Link to comment Share on other sites More sharing options...
Littleroo27 Posted January 2, 2007 Author Report Share Posted January 2, 2007 Unfortunately, I don't have any out of network coverage with the Cigna HMO. The only time I'm allowed to go out of network is if I need to go to an emergency room when I'm out of town. This is my first experience with an HMO and I do plan to work the system as much as possible, but it's certainly more of a PITA then a PPO. Even with a PPO, they won't cover anything done out of the country. I plan to see my new PCP in the next couple of weeks and get started on the 6 month pre-op diet, if nothing else. I can worry about who is cutting me open in another 4 months. Right now I am at my highest weight EVER and feel like crud. It's hard to get up from the sofa or even roll over in bed! I've never had a problem like that before and at 26 years old, it's scary. So far I haven't let my weight stop me from doing anything that I want to do (I've never really WANTED to run or jog, so that's not a problem, lol), but it's really starting to hurt my body. Within the past 15 months I have gained nearly 90 lbs. That is some seriously bad weight to gain at all, much less so quickly. What's funny is that I am not depressed or sad or any of that. I actually started gaining weight back when I began dating a wonderful person and developed a social life. We are just friends now, but the social life and extended friends are still there. And so are my bad eating habits. Littleroo -If your new insurance carrier does not cover Dr. Oritz (as he is not in their network ?) you might be able to get your PCP to request on your behalf that your surgery be covered out of network. You obviously have built a trust with Dr. Oritz and that means everything when one is having surgery. Although I am not a patient of Dr. Oritz, it is quite obvious to me he is held in high regard and is an experienced surgeon. You maybe be able to mention that as well that he has more experience etc.... Good luck but don't take "no" for an answer either. EJ Link to comment Share on other sites More sharing options...
Laura O. Posted January 3, 2007 Report Share Posted January 3, 2007 Six month preop diet? What six month preop diet? Does that mean I can't get the lab band done for at least six months? Link to comment Share on other sites More sharing options...
Littleroo27 Posted January 3, 2007 Author Report Share Posted January 3, 2007 Not at all. The diet is often a requirement of the insurance provider. It's sort of a test to make sure you can stick with it before they pay for some huge operation. They probably figure a certain percentage will wander off because they are unwilling or unable to either do the diet for 6 months or regularly see the doctor or something else. The hospital itself would probably cut me open by the end of the month if I asked them to, since I've already done the pre-op requirements of going to the orientation class and the support group and I have a letter from my psychiatrist proving that I'm mentally stable (for the moment, anyway!!!). But CIGNA requires that I do 6 months of doctor supervised dieting first. Big jerks. Six month preop diet? What six month preop diet? Does that mean I can't get the lab band done for at least six months? Link to comment Share on other sites More sharing options...
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