peteyrulz

I'm in Fredericksburg too! Not sure, at this point, where my surgery will be. Either Woodbridge or Tijuana!

Thank you so much for your story. You answered many of my "surgery in MX" questions. Have a speedy recovery!

I'm having a hard time finding any info on either TM or Dr. Mauricio Gutierrez?

very interesting topic! I have recently discovered that Splenda (sucralose) contributes to my hunger. I stopped Splenda & started Stevia a few weeks ago, and I find I am not as hungry in the morning after my Stevia-laced coffee, as I was with the Splenda coffee. On another note, since I've been post-menopausal, my sweet tooth has been insatiable!

@@della street Thank you for posting! There's so much in this process that is contingent on humans being able to do their jobs right...human error plays a huge role in this process doesn't it? I've been futzing with BCBS since March. Now in external appeal. I'm ready to throw in towel & head to sunny TJ! Good luck to you, keep us posted. We should all write a book: Adventures in Bariatric Sleeve Approval: Fun with Insurance!

CONGRATULATIONS!! Incredible. I see so many success stories here; the positive outcomes are what keeps my impatience at bay. Good for you!

I hear you! I'm enduring the same thing. I'm still waiting to hear the decision for my external review which was filed 2nd week of December. Patience is a virtue, but it's not one of mine! Good luck & I hope we both get approved soon.

I'm hearing that 2 year crap too. In my external review right now, after 3 denials. I hired Lindstrom Advocacy (not affiliated) & they are very helpful. No cost for phone consult.

I feel your pain! I've been playing this game with BCBS since March. I'm currently at the external appeal stage. I'm really upset because if the doc's office had not sat on my records for a month, it's very possible I could have had surgery before Dec 31. BUT NOOO...now I'll have to meet the new year deductible...blah blah blah. At this point I am seriously considering Mexico. Not sure if I'm more upset with BCBS or surgeon's office. This has been one big comedy of errors since the beginning. I could have gone to Mexico during the spring...I would probably be at my goal weight by now. Good luck to you!! I hope things work out for you soon, even if it's next year. Thanks for letting me rant!

omg they're splitting up? no wonder I couldn't get thru to Stafford! This has been one problem after another for me. I hope it's not an omen. ???? I'm not driving to Fairfax, that's for sure. I hope the Woodbridge office is still available.

Interesting! I had a terrible time with their office staff (to include Martha). I never got any info about my peer-to-peer, & to this day I don't know if they ever did one. I had to have my records sent out from there, and it took a month before it got done. I can't say how many messages I left with Martha. Probably 15? Never heard back. This has been going on since July. Just got my 3rd denial, so I think I'll go to TJ.

Don't give up! I've been denied twice with BMI < 40 but I feel positive about my third try. I had NO apnea, HBP, or diabetes, but I have other co-morbs. I hired Lindstrom Advocacy (wlsappeals.com....not affiliated). They are wonderful...their phone # is on website. They can give a free phone consult & will let you know if they can help you or not. Very reasonably priced. Hopefully a peer to peer will be successful. Good luck!

Tiffany you are with Bluepoint Surg? I am sssooo frustrated with their office staff. I can't tell you how many times I have called their ben coordinator & program coordinator in Stafford & Woodbridge. They have yet to return my calls from early September!! I got Lindstrom involved hoping it would light a fire. I've been doing this March & I REALLY REALLY want this done by YE. I'm so disappointed with them right now. Thanks for letting me rant!

Me too! Another vote for Lindstroms. There's no cost to call them. Kelley is very helpful & friendly. They charge a flat fee.

THAT'S AWESOME!!!! I'm SO happy for you! Keep your fingers crossed for me. Sending my paperwork to Walter & Kelley on Monday!! CONGRATULATIONS!!! let us know your date!

I'm having the same problem with BCBS/anthem. My appeal was sent in 9/8. Program coordinator said it took 30 days. Been calling every week. called the number on the denial letter.no one knows anything. Today, after being being on hold for 1 hr I was finally told she's not in. there's an hour of my life I'll never get back! ugh. so, I don't know anything more today than I did on 9/8. Thanks so much BCBS.

My 2nd submittal ( after first denial in June) was sent to BCBS on 9/8, according to the program coordinator. I called on Sep 15, no word from insurance. she said it can take 30 days. I called her again on 9/25, since I had not heard anything. And a 3rd time on 10/3. Every time I ask the coordinator my status, she gets impatient and snippy. I'm thinking, "I'M SORRY TO BOTHER YOU, I JUST WANT TO KNOW WHAT IS GOING ON!!!!" What is with customer service these days? Yikes! Anyhoo...had my a-ha moment a bit of ago...I'll be calling BCBS first thing tomorrow morning. Thanks for letting me rant!

I am going thru the same thing. I gained 10 lbs to meet the 40 BMI but was denied AGAIN because it wasn't over 40 for the entire 2 yrs. it was 38.86 when I started, & I didn't have one of the 3 major co-morbidities. I'm having Lindstrom work my case. i started in March. this is SSOOO frustrating!

My fingers are crossed for you! I'm using Lindstrom after all, as my 2nd attempt was denied. Can't wait to hear about your positive outcome!

this would be awesome! Well not as awesome as having BcBs cover everything but pretty darn close. Still working on my appeal

Hi peteyrulz, I just got off the phone with Kelly. She was so nice. May I ask you why she didn't take ur case? Where are you now with everything? Did u get approved?? Hi Kstuz...They did not take my case because my co-morbidities were not what was required by my insurance with my BMI of 38.86 & I don't have diabetes, HT, etc. I am jumping thru some hoops & I've switched surgeons; my new surgeon's staff is more helpful. Submittal to insurance will hopefully be this week or next. Fingers crossed!

I am so sorry you are going thru this. I don't know what your BMI is....if it's over 40 may I suggest you contact Lindstrom advocacy group. (wlsappeals.com) They will gladly give you a free consult over the phone, and if they can handle your case they charge a flat [low] fee. Nothing ventured, nothing gained. ???? They have helped many on BP. I talked to Kelly, she was very helpful even though they did not take my case. Good luck to you, don't give up!!!

ystdy I had my pre-surgery wellness appt with my new surgical group, Bluepoint Surgical Group in NoVa. I was so impressed with the comprehensive meetings with the behavior specialist, dietician, & exercise physiologist. BP seems to be a very well-oiled machine. I'm so glad I switched to this group for my 2nd try for approval. Dr. Halmi is da bomb! (not affiliated)

I had my first consult today with Dr Halmi of Bluepoint Surgical Group in Stafford. I wish I had picked this practice my first try. I tried to go thru St. Mary's in Richmond VA but I was denied by BCBS Fed in June. My BMI was 38.9 but my co-morbs were not drastic enough for approval. I was very disappointed in the original surgeon's staff; they were not helpful after my denial. I talked to a reputable obesity advocacy group & they suggested I gain the 10 lbs needed for BMI > 40. DONE!!! ???? Dr Halmi & the staff at Bluepoint are amazing so far. I am very excited about my fresh start. I need an endoscopy before submittal & it's all down hill from there. (fingers crossed) I like that they are so organized & have in-practice specialists for exercise, insurance, nutrition, & behavior. BOOM!! My next appt is the 29th for the initial meeting with the Wellness Team. Surgery could be by mid Sep! I AM ECSTATIC!!! ????????????