Jrs_lovely1

I'm in NC as well scheduled for April 20th (Fayetteville)

I am April 22nd as well! Best wishes to you!

I am so VERY HAPPY for you!!!!! This is wonderful news. You and I of course know we share Carefirst BCBS in common & all of the issues we have had, to finally come out with something positive feels GREAT! I have an April date. Do you have one yet? Hopefully we can share that in common as well and continue to support each other.

Hello everyone. last week I found out that I received a denial due to not having the supporting documents demonstrating a structured nutrition program within 2 years preceding the submittal to insurance. I do have the documentation and just sent it to the surgeons office today to forward on to my insurance for an appeal. My concern is yet again the surgeons office. When I was informed of the denial, the administration nurse told me that I needed to have the program completed after the submission to my insurance. I have had issues with the administration part of the office since day 1 and followed up myself and found out that was incorrect. It has to be prior. I am afraid that they are going to hold my forms based off their understanding of the policy. Of course my thought is to submit it myself but my insurance company said that the appeal has to be through the surgeons office. Any advice on this? I'm thinking of asking for a conference call between the office, insurance and myself so that we can all be on the same page. It took forever to get them to submit my packet in the first place. Also what are the chances of an approval after a denial?

Thank you so much! I was so happy to hear those words of "you have been approved!" I almost cried.

Hi! I totally missed this post. My current BMI is less than 35; however, I had a higher BMi at the time of submission. I also have co-morbities so the denial was based on lack of supporting documents

Got my approval today!!!!! I'm do excited & relieved yet a tad bit anxious/nervous. Part of me thought this day would never come. So glad it did!

Quick update: My surgeons office submitted the documents needed in a timely manner. YAY! BUT now I am getting conflicting information. I contacted members service to find out if they received the documents and they stated that they had but that the authorization request had been cancelled???? They stated that they sent this information to my Dr. I contacted my Dr.'s office and they said they had no knowledge of the cancellation and recently submitted the documents. I called the authorization dept. for my insurance (they wouldn't really talk to me as the patient) and they stated that it was cancelled because I did not meet the requirements. They also stated that they sent notification to the Dr.'s office on Feb 2nd. This time frame is in line with the denial. I assumed that they cancelled it before they received the supporting documents. I contacted my Dr.s office and told them all of the information in which I was able to discover and they said that the would follow up. I am a bit discouraged but still going to hang in there and do what I can to pursue this. I don't understand all of the issues though. I was a hopeful of a smooth process.

I am in Fayetteville.

I'm in Fayetteville as well. My surgeon is Dr. Ejeh. Did you have your surgery at Cape Fear?

I sure did!!! I am about 2 years now post braces. I have my permanent retainers and my nightly ones as well. That's crazy.

No. I didn't.

Hi. I am not sure if you have done this or not but you can always follow up with the surgeons office to see if they sent the referral to the nut yet. You my have to bug them a bit but its best to do your part and stay on top of it. I don't have CIGNA but I had similar requirements and I hassled everyone. LOL. but it got the job done especially in my case where my surgeon had just moved offices and was working with staff who had not worked with bariatric patients before. It was a learning lesson for them and I didn't want to be the "student" they dropped the ball on.

Funny topic. I keep having dreams of losing teeth. Not sure what that is all about. I see a dentist routinely and have overall good dental health. My friend did have some issues with her dental health after she had a gastric bypass but in her case she did NOT take care of herself properly after. She doesn't even take supplements. I would think since the sleeve doesn't change the absorption of food and with the aide of supplements, your dental health shouldn't suffer. Just continue to practice good dental hygiene and maintain regular cleanings/maintenance.

I did not have to take off anything. So far they only take clothing into consideration when checking for a weight loss. For example during my weigh ins if I am close to my previous weight, they will look at my clothes and make notes. Of course this is my office practice. Not sure of others.

I had a surgery date of Feb 11 (which I just realized is today ) but I was denied. I submitted my supporting documents that I needed and hoping that my appeal will meet the requirements and I will have a March date! I'm sending my prayers up for each of you and for me as well.

Thanks for the advice. I actually took the documentation up to the office on yesterday after I called to verify the fax and they stated that it was not received. It gave me the opportunity to do what you suggested and write a statement of my efforts throughout this struggle with weight loss. After I dropped the documents off I waited a couple of hours and then called the office to speak with the scheduler. She is the one who creates the most confusion with this process. I asked her what are the next steps for proceeding with the appeal? She said the surgeon was out of the office until Friday. She has to review the documents and sign them before she is able to send them to the insurance. So I am going to follow up on either Friday or Monday. Generally I hate to be a bother but I feel like the only way I have got any results is by applying pressure on her. As far as speaking to the office manager, I did speak to someone (not manager) and voiced my frustration. I also spoke to my surgeon about it and she addressed it. Between my venting and her stepping in, my paperwork was submitted to the insurance. I am open to speaking to the manager, I am just going to see how the scheduler handles this process now. I really hope that once it is submitted I can move forward with an approval. I will keep this updated. Thanks again.

Hello I have CareFirst BlueChoice which is out of MD. I am based in NC but have insurance through my employer who is out of MD. The insurance falls under the umbrella of BCBS. If you do have them, what was your success rate with an approval and the time frame? Thanks in advance.

When i first went to the surgeon I went for a consult on the band. She informed me that she was actually taking out more bands tthan she is putting in, but this is for her patients around the 5 year mark. They are experincing problems with continued weight loss, band issues and health complications believed to have been created from the band. She said that if the patient had increased weight gain after removal or at time of removal, was closer to an unhealthy BMI than a healthy one, most insurances were approving the sleeve. Hopefully yours will do the same and it will be smooth so that you can continue on your way.

Hello. I am at the very beginning of the process and will hopefully be sleeved before this year is out. I am a 31 year old married female in North Carolina. I love the Lord, my husband and children. I would love a mentor who has a solid foundation in their faith and is willing to pour information into me that will help me make wise choices along the journey. Staying encouraged and informed is what i believe will help me make each day successful or more successful than the one before. Thanks in advance for any interest.

I think that your mom may just be doing what she knows to do. You are the one who has retrained yourself regarding your food habits. I don't know if you have straight out told her what food choices need to be in your house and if she was going to assist in that area then these are foods/off limit foods that need to be selected. Hopefully no mother would try to purposely sabatoge their child. Perhaps she really is just doing what she knows to do in her way wi really thinking about the overall life change that you are making.

Hi! Thanks so much for the reply. I am originally from Califormia but have been in NC for a little over 10 years now. Its awesome to have someone else who can relate this to their spiritual walk with the Lord and draw strength. Plus, iron sharpens iron so if you every need some encouragement along way, I am here for you too.

I'm with you. As far as work goes there are a hand full of people that know that I am in the beginning process of WLS. Others don't know not because I want to keep it hush hush but because my absence or state of being doesn't Impact them. As of now I'm thinking of taking about 2 weeks or less off and im saying that I had surgery. Simply surgery. They don't need to know what kind or the how's/whys. I'm a private person, they know I'm a private person so im leaving it at that. Once I return and begin to transform, I plan on revealing. I'm not looking foward to some of the judgement but I'm confident in my decision so going toe to toe with questions is ok with me. I won't be sharing with people who I know just want to me nosey but I'm looking forward to providing some education on the procedure to those who are interested or ignorant. Telling my husband and mother was the difficultiest for me. My husband was supportive but my mom gave me the whole "why, it's extreme...yada yada." I told her that I wasn't asking for advice but I was telling her because she matters to me and I don't want to leave her out of a major event in my life. She is supportive now. She doesn't agree with it but is supportive nonetheless. My sister is the only other family member besides my hubby and mom that know. No one else will know until it gets closer or after. Depends on who it is. Again, it's a known fact I'm private so me going off the grid for a bit won't seem too questionable. I do have to inform my church. It would be odd for me to miss several weeks in a row. Also my Pastors are my cousins so it would be even more odd to miss and not have a good reason so I have to tell them it's surgery and it's elective and nothing's wrong with me. Ultimately I think it's your business. It's ok for your surgery to be on a need to know basis if you desire.