kaninag

Have all your doctors write a letter for you saying why they think you need the surgery...that will help

Ok, I can finally log onto my new EmpireBlue insurance stuff and I went under their medical policies and was a little surprised...NOWHERE does it say that you have to have had a BMI >35 for x amount of years....Regular BCBS policy does....This helps me (I think/hope) cuz CURRENTLY my BMI is 43 it has been over 35 for the last 3 years but not over 40...is this good...somebody please tell me if it not in their medical policy then it doesnt apply!!!??????

I had a similiar problem...except mine was with my actual weight loss doctor...he didnt want to fill out the paperwork either. I would just get a copy of all your records...surely they recorded your weight...you surgeon can write a letter stating why you need the surgery. Good luck to ya! Remember the goal.....no matter what crap the doctors or insurance company puts you thru!!! I don't understand why this process has to be so difficult!

Thanks, I will call the doctors office after the holidays. I hear that Empire Blue is somewhat easier to deal with...which makes no sense to me as they are still BCBS. I hope now to HOPEFULLY have my surgery the end of january....so......here we go again Anyway, Thanks a lot for your support!!!!!!!! HAPPY NEW YEAR!!!!!!!!!

Insurance prob still wont pay for it. BCBS told me that your BMI has to be >40 for 3 consec years! Look at their medical policies

I'm sorry but if you're going to a bariatric surgeon then they know the rules of the insurance companies by heart....when you were found to be - for sleep apnea they should have stopped right there.... most insurance companies also say that if you have no comorbidities then your bmi has to be >40 x3years not just a few months....good luck to you but I would def be worried about that doctors office... maybe you can still get approved though...do you have shortness of breath, high cholesterol, arthritis, lower extremity swelling? These are all things that could possibly help your case.

No-I have to refile.....which SUX I REPEAT SUX! I told my husband I give up....I'm gonna go thru all this and their gonna DENY me...I mean cuz honestly I'm not that sick.....But at the same rate....I dont wanna get sick bc I keep getting fatter you know.......oh well EMPIRE BLUE HERE I COME!

Can you tell me what their requirements are? I just filed for the surgery with BCBS PPO but my insurance changes to Empire BCBS PPO jan 1 and i was told i would have to refile....just wondering how strict they were....

I guess God is telling me not to have this surgery. I finally got in touch with a case manager at BCBS....ok she said she will try to rush the approval and hopefully have a decision by tomorrow...no guarantee but thats better than nothing...so I called the doctors office and now he is out of town until 1/7.....so I wouldnt be able to have it this year anyway....then I asked the girl about my insurance changing and she said that we would have to REFILE EVERYTHING!!!!! ARE YOU KIDDING ME!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I couldnt believe....so I have wasted all this time and energy only to be slapped in the freaking face!!!!! I have to go thru all this crap again....my new insure empire blue goes into effect 1/1 but she said she would see if they would go ahead and let her file a claim...if so she would send all the info tomorrow.....this is AWFUL!!!!!(

AAAAAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!!! You know, after reading about a lot of ppl's speeding approvals I kinda expected mine to be fairly quick....I TOTALLY SHOULD HAVE KNOWN BETTER...this is crazy!!! STILL NO WORD!!!

there is numbing cream that your doctor could give you a prescription for...you put it on about 1 hr before accessing your port. The brand name is EMLA but its lidocaine and prilocaine....I THINK... anyway in my office we have a lot of pts who use it for their mediports and they all say it works wonderfully.

Thanks Ellisa!! Well, still no word That's ok no word is better than a denial......

Ok I have to ask this of the lower BMI bandsters.....is your insurance covering this do you have comorbidities? Kinda tell me about your insurance approval process??!!!

Oh also, BCBS of AL will take weight watchers etc but you have to be see a dr at the same time! and they have to record it in their notes about you! make sure you see a dietician because they require that as well. lets see am i leaving anything out...oh they also require a psych eval but your surgeon has the option to waive that. if you go to BCBSAL.org and and register....then go to medical policies click on alphabetical and look for surgical management of morbid obesity those papers tell you everything that they require!!! Good luck to ya...and remember they will take their sweet time in approving you

According to BCBS of Al the 6 month weight loss has to be attempted within a year of submitting for your surgery. I would go ahead and get started. And make sure you go to a good doctor that records everything youre doing to try to lose weight. Yeah insurance company wants you to lose weight so that they can deny you and your surgeon wants you to stay where you are so he can do the surgery. Be careful how much you lose. Because they will deny you. On the surface (paperwise) you do as much as you can to lose the weight!

Oh well, I am not having the luck of a quick approval. I have 3 hrs left to get it approved so that I can have the surgery this year. It doesnt look good. My Dr's office closes in 3 hrs and 10 min and wont be back open again until the day that we had tent. scheduled my surgery *tears* I just called BCBS and it is still in review.....this sux. I am so depressed now. Well, I will just call back before the dr's office closes that will be my last hope.....yeah I know I am whining....but I cant help it. If it doesnt get approved today then i have to pay for 20% of the cost...and thats IF they approve it...surely they wouldnt make me wait so long if they were just gonna deny me...maybe somebody is in the Christmas spirit..............

You know lpn's work just as hard as RNs and have just as much knowledge and you guys get a lot more hands on training. for them to put you guys as pill pushers is just wrong. in our office we have one lpn amongst many rns but you know what she works just as hard as we do and knows just as much!

wow 2 years!!! Well, much CONGRATS TO YA!!!!!

*the BCBS girl said there was nothing they could do at this point to rush anything bc it is under "medical review"

Yeah, I just called BCBS again and they kindly reminded me that predeterminations are done as a courtesy and that it can take up to 30 business days....basically they're tired of me freakin calling but you know what if i dont have an approval by tomorrow then i can just hang this up for this year. which sux!!! I am soooo frustrated. I hate that my surgery lies in BCBS's hands....

Congrats Ellisa!! I did read that thread and you went thru a lot!!! Luckily I have read all these threads and I knew what to expect. I only gave them a few days to get the paperwork and when they still didnt have it in the system I refaxed. I'm not playing with these ppl. You know to me-- I want the surgery. My BMI is high I have done everything that they asked....now give me my freaking approval...you know......but yeah I know it doesnt work like that. I want SOOOO badly to call today but I will wait until friday. If I havent been approved by friday then I wont be having it before the end of the year. But oh well as long as they approve it.:clap2::clap2::clap2::clap2::clap2::clap2:

I called again and they did receive everything!!!!! :) :) I am currently under review!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Thanks for all the support!!!!!!!!!!!!!!!!!!!!!!!

Does anyone know another number to BCBS of Alabama besides the general customer service number? These ppl that I talked to yesterday dont seem to know what they're talking about. They said they have not received any of my paperwork. And then they said that it would need to be refaxed for medical review....which we did yesterday. How in the world did some of you get approved so quickly when I cant even get to talk to anyone that says they have even received my papers (which were faxed last thursday and yesterday.)

I can't stand the wait. My surgeon submitted everything yesterday. The girl at the office said she tried to get it approved online but BCBS instantly denied it.....AHHHHHHH that makes me feel even worse. I am currently at like a 43 BMI but I havent been above a 40 BMI for 3 consecutive years total I have been above 35. I AM SOOO SCARED THAT THEY ARE GOING TO DENY ME. They don't understand that I have TRIED EVERYTHING AND ALWAYS GAIN THE WEIGHT BACK. 4 years ago i did slim fast I lost 40 lbs within 3.5 months. I gained every bit of it back in less than 2 months....what did I do I slowly started adding small portions of my fav foods but it didnt matter that i continued exercise and only let my calorie intake slip 1-2 times a week..NO the weight just poored back on WAY easier than it came off. I have tried ATkins, weight watchers, slim fast, hydroxycut...I think I have taken every diet pill ever made...This year I started seeing a weight loss doctor (b4 I heard about the lap band) This started after I got my wedding pictures back...I was SO DISGUSTED..You know I tried really hard to lose a little weight before I got married...our schedule was really crazy and we ate out alot but i would totally limit what I ate and I drank tons of water....INSTEAD I GAINED 10lbs!!!! within 1.5 months after seeing the weightloss md I was down 20lbs. I THOUGHT AWESOME I HAVE FINALLY FOUND SOMETHING THAT WORKS FOR ME!! WWWRRRRROOOOONNNNNGGGGG..School started back and I didnt have the extra time to exercise. Plus between school and work I was exhausted. I didnt change my eating habits I continued low cal low fat no sodas and I was taking adipex so i only ate 2 meals a day And was doing well.It was like forever I didnt lose anything and they would get on to me bc I wasnt exercising but I did small things like take the stairs at work...then Adipex made me really have intestinal problems so i had to stop taking it...the weight just started pouring back on. i felt like i was starving all the time</p> <p>My problem----I dont have any serious co-morbidities.....I have arthritis in my knees bad, my legs within the last year have started swelling everyday after work (I never had that problem), my cholesterol has crept up to almost 200(and it was close to 100 2 years ago) and I am only 25, and I get real SOB easy. But after reading BCBS's website you have to actually have sleep apnea, or heart problems.........</p> <p>I'm freaking out cant you tell. I think my biggest problem is deep down inside I know my husband wants a smaller woman...I dont care what he says. I have seen the pictures that he used to look at...I dont feel sexy I dont feel pretty....I just want to feel like me again......I'm so nervous that I am gonna get a big red DENIED stamped on my papers. I can't handle the wait...and I cant handle rejection.......not anymore. </p> <p>People talk about breaking points...mine was when My great grandfather whom I had not seen in a long time came up to me and said WOW YOU HAVE GOTTEN REALLY FAT...I ALMOST DIDNT RECOGNIZE YOU:help::think:think:think

Jelbel, our insurance switches to empire BCBS in January. but the bad part about that is now BDBS will pay 100% but after january they will only pay 80% plus i would have my deduc. at this point i dont care....just please approve me!!!! Is monday too soon to call and make sure they have everything?