By: Sheryl Sowell | Category: Health & Fitness | Issue: August 2012
Roberta Wagle, bariatric coordinator at the Lap-Band® Center of Oklahoma at Pinnacle Specialty Hospital.
Roberta Wagle, bariatric coordinator at the Lap-Band® Center of Oklahoma at Pinnacle Specialty Hospital, sees it all the time: patients waiting until the end of the year to move forward with their non-emergency or elective surgery. “Many people meet their insurance deductible in October and think they can wait until then to schedule their non-emergency surgery,” says Roberta. “What most don’t realize is how long the insurance process actually takes – it’s often two to three months. If someone decides they would like to have the Lap-Band® procedure done or need to schedule gall bladder surgery, they really need to begin the process in August.”
The insurance process is lengthy for any non-emergency procedure, especially the Lap-Band® surgery, as insurance companies require that the surgery is proven to be a medical necessity. “Patients often think they can simply meet with the surgeon and set the surgery date. For some non-emergency surgeries, and the Lap-Band® procedure in particular, several steps must be taken,” Roberta explains. “Patients first attend an educational seminar. Then they have a personal consultation with the surgeon. Next, the patient must meet with their primary care physician, undergo a dietary consultation as well as a psychological evaluation, and complete any other preliminary work that must be taken care of in order for the insurance company to have a complete letter of medical predetermination for the surgery.”
When you think about it, it makes sense that the process takes so long. It can take a week or two to schedule an appointment with the surgeon, another week or two to get in to see your primary care physician, an additional week to have the psychological evaluation scheduled – and so on. “In addition, the surgery itself has to work with your own schedule and the surgeon’s schedule,” says Roberta.
After the predetermination letter has been mailed, it often takes the insurance company 30 to 45 days to reply. “If you’re interested in Lap-Band® surgery, or if you have any other non-emergency medical situation you want to take care of, such as gall bladder, cataract, breast reduction, or joint surgery, we strongly advise beginning the process now.” If you initially visit with the surgeon in August, the surgery itself can still be scheduled for November or December.
“Basically, the insurance process takes a lot longer than people realize. If you know you are going to meet your deductible in October, the month of August is when you need to start the process of proving medical necessity to your insurance company,” adds Roberta.
Dr. Ladd Adkins of the Lap-Band® Center of Oklahoma offers exclusively the Lap-Band® by Allergan to people who are medically classified as morbidly obese. The Lap-Band® Adjustable Gastric Banding System is the only FDA-approved gastric banding system for patients who are at least 30 pounds overweight, with a BMI of at least 30 and one or more obesity-related comorbid conditions, including coronary artery disease, type II diabetes, hypertension, sleep apnea and osteoarthritis.
Those with the greatest success pay close attention to the foods they eat and exercise regularly, and typical weight loss is one to two pounds a week. Some foods are more difficult to digest than others, such as breads and starches. As Dr. Adkins explains, “The system actually forces people to make healthier food choices. But that’s what they need to turn their lives around.”
The next free Lap-Band® educational seminars will be held at 7 p.m. August 9 and September 13 and 27. Call (918) 392-2806 to reserve your spot.
Lap-Band® Center of Center of Oklahoma is located in Pinnacle Specialty Hospital in the CitiPlex Towers, formerly the City of Faith at 2408 E. 81st St. Pinnacle Specialty Hospital offers state-of-the-art technology and personal services in Lap-Bands, ophthalmology, pain management, orthopedics, wound care, and sleep studies.
Sheryl Sowell was born and raised in Tulsa, OK. She graduated from Will Rogers High School and received her Bachelor of Arts in English from Northeastern State University in 2007. She has worked for Value News as editor, writer and advertising copywriter since 2008. She enjoys meeting and interviewing people for Value News articles, learning about their backgrounds, and helping to promote their businesses and local events. In her free time, she enjoys reading, trying new recipes and crafts from Pinterest, attending concerts and sporting events, and spending time with family and friends. Sheryl lives in Tulsa with her fiancé Paul, their daughter Scarlett, and their two dogs, Gunner and Boo.