OldskoolHeart

Hello Pre-Post Sleevers, The time has finally come. Like most of you I have done everything you can possibly imagine. I have been in/out of doctor's visits for about a month in a half. I have had tubes, stickers, pins, and needles in me as well. Now I have come down to the last road, I have no more appts. Can you fellow sleevers who used their faith and belief in God to pray that I will have a surgery date in the month of September and that not only the surgery appt will go well but that the surgery will as well. I am so excited and nervous not only for myself but for those who have wanted the surgery fo a very long time. I know how rough the journey can be, and I am so glad I am at the end and there is light at the end of the tunnel. Please also if you have any encouraging words, I will taken them. Thank You, OldskoolHeart

Also, the letter of medical necessity doesn't really state much other than diets you may have tried, your bmi, your age, and what the doctor thinks will help with your obesity, which is the surgery, doesn't state much and also your co-morbidities. Sorry I kept forgetting stuff. I work for BCBS-IL and also some other states so if you need help let me know

The only thing you need from your PCP is a referral with your BMI from this year, thats it, you're pretty much done with him/her unless you want to do some of the requirements such as xray, labs, ekg, or etc with them to get some stuff done quicker

You can go to another provider if you think that one will screw you over. I know I did. I did not like the first provider I had and she had my bmi all wrong and didn't want to give me a referral even though I qualified. I just dropped her and went to another provider. Depending on your insurance-group they may have specific guidelines for you to follow when sending in your predetermination such aS a letter of medical necessity. I know BCBS-IL standard guidelines for Bariatric Surgery is a letter of medical necessity usually done by the surgeon and the coordinator you are going to go see for the surgery and all the program requirements. It is not usually your pcp that does it.

While you do that get EVERYTHING done that you can. Labs, Xrays, Endoscopy, EKG, Psych Eval, and etc. If your using a one stop shop ask them if you can do some stuff on your own since you have those classes so wheb your done you can just submit for approval

I actually started a lot of things before seeing the surgeon. I had completed my referral, diet & sleep history, psych eval, physical with pap, some lab work, and attended all seminar classes. Those things you can complete on your own to speed up the process. Most bcbsil plans have no referrals so a lot of stuff you can just get done. If you want this to go fast do some of it yourself dont wait for them to "fit" you in to their appts that they have with fifty million other people.In my case there are only two bariatric surgeons and one was away for the whole summer. I refused to wait in line, I did my own ekg with my doc, add. bloodwork and met with a cardiologist. I also.went and did my own xrays. They wanted me to see the cardiologist 9/19. Oh I dont think so. Lol...Find out what needs to be done and if your pcp can do some of it, go to them if not either go with who the surgeon perfers or go online and find a specialist in network with bcbsil. The only thing I let them take care of was meeting with the dietician and endoscopy. My surgery date is 9/26 and to be honest my referral was sent on7/15 and I didnt meet with the surgeon until 7/29. The only thing that made it go by slower was I am very young and he wanted to see how well I did on the preop diet. Down 12pds in about a month, see him for a follow up on Tuesday. Call BCBSIL ask questions about referrals, your GROUP specific guidelines and/or BCBSIL guidelines, in network specialist and your cost. Hope this helps :-)

carolinagirl1991 I was at 40 with no co morbidities

September 26, 2013 Sleever!! I'm excited and nervous and excited all over again. Anyone interested in keeping touch or talking through email and stuff about their anticipation, fear, etc?

Thank you so much Kasiesalas for the encouraging words, its like receiving a good high five, much appreciated!! Shedevil-We are almost there, what a long road it has been. I pray everything in return to you. We have been through a lot and I cannot wait to see our results. I know for me as well as you it has been a dream come true to finally look and see yourself differently. I will be praying for you and thank you for the encouragement!!

Great to hear, this thing wouldn't let me send you a reply a couple of days ago. Good that you are almost done, so I'm I. I will be done next Tuesday seeing the surgeon for my second visit, should have surgery date in Sept. Anything you need let me know!!

NO NEED TO BE CONCERNED. YOU CAN CHECK WITH YOUR INSURANCE TO SEE IF IF THE GROUP YOUR FATHER IS INCLUDED IN COVERS BARIATRIC SURGERY AND IF SO WHAT ARE THE STIPULATIONS OR DO THEY FOLLOW THE GUIDELINES OF BCBS-IL. LET ME KNOW IF YOU NEED HELP WITH THAT I WORK FOR BCBS-IL

I just came back from the Doctor she said my BMI is at 39.7. Do I have to exactly be at 40 in order to get the surgery? Im not sure I have 2 comorbidities so I wont qualify. She said she could just put me at 40 if need be but if my paperwork sats 39.7 insurance will reject it, correct

I'm all good to go, go see the surgeon tomorrow. I have completed pretty much everything else except for the dietician which I will schedule tomorrow. Beyond excited and nervous!!

Does anyone know if insurance companies specifically BCBS-IL will take a BMI of 39.7 as 40 or do I have to have 2 comorbidities in order to qualify since Im not ifficially at 40?

So they must have just rounded up for you. I wonder if I call BCBS will they just round up or should I just go with seeing another physician and just have the BMI at 40 already. I mean 39.7 is really 40

Hello Sleevers, I have a dilemma. I went to a physician I've only been to one time in the past 24 months. She had my bmi at 39.7 (ridiculous) and I have no co-morbidities. Can I get a referral from another physician and send in only that information to the sleeve surgeon. I really did not do anything with this physician, I sat with her for about 15 minutes. I have scheduled myself to meet with another physician before my surgeon iniitial visit on July 29th where I plan to get a referral. Does anyone know if that is okay, I just want to make sure I am able to do that. I know some of you said you gained weight in order to be covered, did anyone have to go back to their physician with weight gain, and were you successful? I so want this surgery and I'm so close, I don't want a BMI of 39.7 to mess this up. Help me please!!

Hey Guys, Did most of you guys wait untii the surgeon told you to start your diet or did some of you begin the pre-op diet on your own. Also what seems to be the best Protein shakes, or does everyone use powders?utm_source=BariatricPal&utm_medium=Affiliate&utm_campaign=CommentLink" target="_ad" data-id="1" >unjury? Please know your comments are so appreciated. Thanks, OldskoolHeart

So Ive been to her once, can I go somewhere else and just wear weights or something, Im sure I'll only need a pound since Im at 39.7?

Yes, its the best plan ever. I'm so happy that I have it. Surgery should be approved real soon. My doctor already has my bmi at 40.2

Congrats. I had a similiar situation, my group plan opted out. I am now with BCBS-il and their plan is super easy. Hopefully my surgery will be in late August as well.

Thanks for the advice @bollettieri3 I am going to try to enjoy the time while I can. Going through the process right now.

Thank you so much for sharing your journey. I am so excited to start this process and I hope that I will have similiar success. God Bless!!

Thank you for the advice. I think I get so excited that I want to tell everybody not thinking that everyone will approve, not that it matters. EWhitt-You are hilarious. Prayergirl-I will take your advice to heart. I'm excited and nervous all at the same time. I just want to do this and get to a better me, some people won't/don't understand that.

Hello Everyone, As you can all tell I am a NEWBIE and I'm just about to start the journey of the sleeve gastrectomy. i have not told many people but the little I have told have already tried to give their "advice" of what they have "heard" or what they think they know. As I will need to tell more people i.e. family, friends, and etc, how do I deal with the negative advice? What are some tips to deal with those type of people? What are some tips/advice for a newbie like myself just starting to go through the process. Some do's and don'ts if you will. Any advice from those who have done it or currently going through it would be great!! Thanks, OldskoolHeart P.S. I would like friends, please add me if you want someone to talk too!!