Northern Mist

Little Richard?

Hmmmmm... I have to think about this one. I think it's a male but not positive.

Is the pre-op diet mainly to shrink your fatty liver or did the surgeon require you loose a certain amount of weight prior to surgery? or both? If it's to loose weight - how much did your doctor require? Thanks

Congrats! Amazing results in such a short time. Proof we need to drop the weight to become healthier. I can't wait to have my surgery!

Mariah Carey (sp?)

Those eyes are McDreamy! from Grey's Anatomy. Patrick is soooo sexy!

You are more than welcome to bring people with you - most do. No talking unless you want to - it's mainly listening. If you don't like crowds sit near the exit - if it gets to stressfull go in the hall for a couple minutes and take a breather. You'll be ok - it's not as stressfull as I had thought it would be.

I'm waiting to hear from the surgeons office for a date or possibly to redo some of the paperwork/signatures since it's been so long - I'm thinking it's going to be in January though. And yes this is a tough one!

It's a tuffy!

Freddie from nightmare on Elm St.

It can be fast and easy or forever with BCBS of Il. It took me over two years and 100's of pages of documentation. My physician would go over my weight watchers logs day by day and make notes about the food choices and my activity on every single one of them and they still told me it wasn't good enough documentation. A letter from a lawyer was the trick for me. I really hope you are lucky and have a quick approval. All I can say is call the BCBS rep. and do exactly as they say - write everything down and repeat it every time you see your physician overlooking your diet and activity levels. You have to show that you are progressing every visit. No falling off the horse I was told or they think you will not be able to follow your band "rules". Ask your surgeon if they sent BCBS every single page you submitted to them - I have heard that they can lose things or just not send them in. Good luck and do not give up!

Finally! After 2 + years and literally 100's of pages of weight watchers logs, monthly physician reviews, etc.... I'm approved. BCBS of Il. denied me three times - I wore them out I'm sure. Yay me!! Now what? I was so caught up in the fight I forgot what's next - how funny.

I have to thank my husband and my doctor. Both new I was doing everything right - I just had to show BCBS I wasn't giving up.

Finally! After 2 + years and literally 100's of pages of weight watchers logs, monthly physician reviews, etc.... I'm approved. BCBS denied me three times - I wore them out I'm sure. Yay me!! Now what? I was so caught up in the fight I forgot what's next - how funny.

What did you do exactly? I just received my third denial and they keep telling my doctor and I the three month supervised diet notes are not detailed enough and they don't show progress ie: adjust diet - adjust exercise - lose weight over the three month period. We think we're doing great and then they burst my balloon again. Any hints or tips? I'm tired :tongue2: Thanks - Misty

This will be the third time information has been submitted to BCBS of Illinois so I'm anxiously waiting for a yes and not another denial. I don't understand why some of us have such a hard time getting things approved......In my BCBS of Il. group contract WLS is covered with the normal conditions attached. My doctor has done the 6 month diet, etc...with several people a year for several years and has not run into a brick wall until my insurance company. BCBS stresses the need for a 6 month medically supervised diet and in depth notes at the monthly visits - we have done this twice with no luck. This time I added 10 months of Weight Watchers to the packet along with all the other requirements so I hope I get a yes. It has been a little over two years since I started this process!!! (July 1, 2009 BCBS dropped the requirements to not needing a 5 year obesity history and only needing a 3 month diet-maybe this is a good sign???) Sorry for the long winded rant - I'm frustrated and hoping for a yes this time. Thanks - Misty

Ok, I have been going through this for a little better than a year now and am sick to death of playing BC/BS of IL. games. I was denied the first time because they said my doctor wasn't specific enough in her notes about my 6 month diet and she didn't put her signature on a required 5 year history form - It had the letter head and was included in the packet of information, but it wasn't signed. I went through another 6 months of dieting and my doctor writing a book every time I seen her and she signed the 5 year form only to submit everything (once again) on June 2nd and be told on June 18th that it's still sitting at BC/BS and "they" are not sure why it hasn't been forwarded to the review board. I called today to check to see where the file was at - A very nice and perky rep. says, "Wow, you've been doing this for over a year now." - I gritted my teeth and nicely said, "Yes I have, please check on things and let me know where my file is and if someone has deemed this procedure medically necessary, thanks." She put me on hold forever.... (I admit I took this as a positive sign) only to tell me, "Yes someone has it but they're on vacation until the end of the week." AHHHHH..... I am so frustrated! Thanks for letting me vent once again.

How much did it cost you? How long did it take? I heard Obesitylaw.com is slow to get back with you, are they? Thanks for answering my questions.

I made an appointment with my doctor to discuss what she thinks we can do/start another 6 month diet. I'm also considering going to a local lawyer and getting a letter wrote with a whole lot of legal mumbo -jumbo demanding I get a better explanation of denial or an approval??? We'll see....

My plan is PPO. I submitted 6 consecutive months / 6 individual doctor evaluations stating all my vitals; height, weight and blood pressures, my BMI, my exercise routine for the month, my food intake/calories for the month and what she thinks I should/shouldn't do the following month. I also submitted all the other pre-req.'s 5 year history, did all the tests the surgeon ordered, psych. eval., physician letter, orthopedic surgeon's letter (bad knees), etc... The first denial said my doctor didn't make enough notes at my 6 month evaluation and she had failed to sign the five year history - even though it was on letter head. Second denial said I lacked a six month clinically supervised diet...... It's frustrating because BC/BS lets a board make the "Medically Necessary" decisions but they cannot give you a name, number or extension to this MRU board in order to get a clear answer on why they denied it or what you have to do to get approved. The terms and policies are so general a lot is left up to interpretation and that is where they get you!

Sounds like they have a million different plans and divisions. Why is it some people have to do a six month diet and some don't? I thought the whole point of the diet was to see if you could adhere to a diet plan etc... Do they think some of us (based on geography or where we work??) are trustworthy and some of us are not? Who knows.

I got the news yesterday I was denied once again and for the same reason - lack of a 6 month supervised diet. I have turned in two different 6 month clinically supervised diets, followed the excersize and nutrition advise on both, lost weight on both and they still deny me. I'm not giving up because I have been on this insurance for 14 years and have never used it beyond once or twice a year. No surgeries or major medical expenses (besides having my two kids) - it's just the point now.

I'm insured through my husband's employer GADCO. It has nothing to do with employer but everything to do with your policy negotiations and what is finally set up - Some companies exclude certain things/surgeries to save money.

It sucks, I know. I'm still trying to get approved - My doctor has made several phone calls and has wrote a couple of letters. I get frustrated and stressed out every time I call them or think about it. And yes, it's extremely aggravating when the insurance rep is playing dumb!!! Exactly who do we call to get information on our coverage if it isn't them?? My husband is helping by staying positive when I'm ready to quit - thank goodness for his support. Good luck and don't feel bad for venting - the people here know what it's like. Anyways..... venting always makes me feel better : )

I hope you have better luck than I did. I was told (after my denial) that only one visit a month was required (per my policy) but my doctors notes were not lengthy enough - apparantly short and to the point is NOT what they're looking for. My doctor has now become verrrrry long winded in her notes at every visit! I've seen people with BCBS Il. fly through the first time and some fail over and over. We shall see......