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That's awesome news, congratulations!!! It's also very helpful seeing that Anthem of CA was very quick with the approval. I participated in a medical weight loss program last year and provided my surgeon's office with documentation of the visits. They told me it looked like enough for Anthem, so your post gives me hope mine will be approved without any issues. Thanks for posting!

OMG I've been meaning to update you! Lol! The seminar went great, Dr. Tran wasn't there but I ended up doing my consult with him anyways. I brought in my documentation from the medical weight loss clinic I used last year and he said that should be enough for insurance to approve (it was 8 months). So he got me set up with 2 NUT appts, and I already completed the first one. I have my endoscopy this Thurs, cardiology next Mon, and Pulmonary the last week of this month. My therapist wrote up my evaluation and she'll send it to Dr Tran's office this week. So I'm hoping they get it next week and submit to Anthem for approval ASAP, and hopefully I'll have a date scheduled for late March? Fingers crossed! ????????????

No, it doesn't. However they're prorating the amount since the surgeon only requires me to take two classes instead of 6.

Well that worked! I brought my weight loss program docs in hand when I went to my consultation, told them that I had been looking into this for quite some time and had even allowed myself to get talked out of it in 2012, and I've even considered going to Mexico if insurance gives me a hard time. They told me that I would definitely have to do a some nutritional counseling with the program and do all the medical clearances (perfectly fine), but how many sessions is determined by the surgeon. The surgeon came in and asked me what surgery I was looking into, I told him VSG, he looked at my documentation and said that he thought two nutritional sessions would be fine for me. So they're going to submit for approval once I get the rest of the medical clearances, and he said that March/April should be a decent time to look forward to surgery if all goes as planned. So they're getting all my appointments set up as soon as possible, and hopefully I will be on my way to a better life sooner rather than later! ????????????????

Yeah, I'm trying to get that documentation of all that now. I did read that surgery in Mexico was a deductible health expense, therefore I could get reimbursed by my FSA. I have a consult with a new surgeon tomorrow (I wasn't too keen on the first place I had a consult), and I've already got some of the medical clearance items checked off, just need to have those records transferred to the new place. The first bariatric place ONLY wanted me to use their psychologist for the eval, who happens to be out of ALL networks and would cost me $300. I didn't like that too much. Why would they refuse an evaluation from my regular therapist over someone who will have only met me once? Pfft. Anyways. Lol! The new surgeon is much closer as well, which works when I'm admitted since people will be able to get to me faster. And thanks for the perspective about my body....I appreciate it. I try not to feel so negative about it, because it's the only one I've got. But there are those days when I'm just like "What happened to youuuuuu?" ???? lol. I wasn't always overweight, but I always struggled with it because I was considered bigger than average growing up by everyone else. Now when I see pics of myself in HS I'm like "Holy sh*t, I was the original Beyoncé! What was I thinking????" ????????????????

And part of my concern since I have no comorbidities, is if I lose enough weight during the six months to put me under 40 BMI, will the insurance company still approve me? Because then I'll be really mad. Lol

My BMI is 41ish, no comorbidities. I've done so many diets, I could probably write winning diets for other people. Lol! Last year I did a "medical weight loss program" with a company for about 6 months, where all they really did was monitor your weight and prescribe phentermine. I lost about 20lbs and as soon as I stopped the phentermine I gained it lol back plus some. I'm at my biggest now, around 257-260 at 5'6", and my depression is getting worse. I work from home, which kind of makes isolation easier and depression worse. I just really need this. I say I need to do it on my own timeline because I can't fathom waiting yet another 6 months, only to Celebrate another birthday still fat and still hating my body, and still trying to get it back to what it used to be. This is the year I plan to focus on myself, because I've focused on others for so long that I lost myself in the process. A bad relationship wasn't helpful, either. And my daughter is an amazing, fit gymnast and I just want to be a better role model for her. I want her to love her body and take care of it, and I need to lead by example. I figured that if I wait for insurance, I'd pay no more than $3k out of pocket. I have an FSA that will cover $2550 of that. If I pay for the procedure in Mexico, I know I'd pay more but I feel like at least I have more control in the timeline. And of course, a part of me is just being impatient, wanting almost instant gratification. When I want something and have done the research, I want it now and just hate waiting. My therapist understands, but she's not too keen on me leaving the country for this either. However I always make sure I research everything I do, so if I do choose that route I will be confident in my decision.

I don't have an HMO. I have a PPO. Okay, for whatever reason my response was censored? ???? I don't have a Health Maintenance Organization. Lol

It isn't Anthem so much as your medical group or IPA. They're the ones who actually review and approve your surgery. I would say (I do this as part of my job) that no, receipts from WW aren't sufficient, but copies of your weekly book show you consistently showed up for meetings. Additionally, if during that time you met with your PCP and discussed your weight loss efforts, that also helps. The goal here is to show that you've made an honest effort and show consistency in adhering to a weight loss program for more than a month or so at a time - because that 's what you need to be successful with the surgery. I would call your IPA or Medical Group and ask to speak with the person who reviews bariatric surgery requests. Talk with them directly and you'll get the best answer. People who answer 800 numbers have to answer every question under the sun and they aren't part of the review process. I'm not even sure who or what my Medical Group/IPA is. I just know that I spoke with the pre certification group at Anthem to ask them for their requirements. How would I find out who my medical group/IPA is? I'm starting to get annoyed with the whole ins process, and I'm contemplating just doing self-pay in Mexico so I can do it on MY schedule and not the insurance company's schedule. I have a feeling they're going to make me wait the entire 6 months, and then that still doesn't guarantee approval and I'll be so pissed if they didn't approve me after all that. Lol

It depends on your plan. Some I've heard accept a narrative from your PCP stating that you've been under his/her care, others may require you participate in a medically supervised weight loss program, along with records of each visit weight lost, etc. You just have to check with your plan for specifics. It's good to know before you go to the consult.

I'm so sorry for the loss of your fiancé...I can only imagine how hard it must've been dealing with such an ordeal. ❤️ I'm not familiar with NC BCBS specifically, but it's pretty standard of insurance companies to require a psych eval, cardio and pulmonary clearance, and most require that you've done some type of non-surgical weight loss program for anywhere from 3-6 months depending on the plan. I'm just starting the process myself and have Anthem BCBS, which requires 6 months. Thankfully I have documentation of my previous efforts, so maybe it will cut down on the wait to get it done. You should try calling your insurance company to ask about the benefit and what they require. They'll likely refer you to documentation of their policy on WLS, which spells out all the reqs. Good luck!

What are "WW receipts"? Weight Watchers Receipts.

I didn't get any bloodworm done at mine. The nurses took my vitals and history, then the surgeon came in and talked to me more about my history, the surgery, listened to my lungs and heart, and sent me on my way to make follow up appts for the psych eval, etc.

I'm just starting out as well. Went to my consult on Monday, but I'm not sure if I really want to use this doc. The psych eval is $300 out of pocket, and they won't let me use my current therapist. Not sure I like that, plus it's kind of far from my house. I live in Silver Spring, MD and it's in Fairfax, VA. They did give me orders to get my EKG, abdominal u/s, chest X-rays, and EGD, scheduled, so I've got them scheduled and if I do change surgeons I can still use the same reports. I'm going to a seminar for another surgeon closer to me at Howard University Hospital, and I've heard great things about them. Both places are Centers of Excellence, so I should be good either way. But I did like the fact that Howard will allow me to use my own therapist for the psych eval. I mean, who can better determine if I'm able to handle such a life change, than the provider who has been seeing me for a couple of years now? Just makes sense. The only thing I'm not too happy about is the 6 month program. The first surgeon said it HAS to be medically supervised through them, but never bothered to verify my insurance when I have actually asked them. Anthem Blue Cross told me it could be any weight loss program like even WW. Inova told me no, that's not true. I actually spoke with the pre-certification group and they directed me to the medical policy where it states that it should be a non-surgical attempt for 6 months in the last 2 years, evaluated by the requesting physician. Anyways, I have invoices/records of the medical weight loss clinic I joined last year, and I'm going to try to use those. I just want to get this done ASAP so I can start to feel like a normal person by the time my bday rolls around in June. Lol

You look amazing! Congrats!

I'm nervous....what happens during the consult, anyways? Mine is next Monday morning.

When discussing my plans with my close group of girlfriends, I got "Don't you want to hire a personal trainer and give it one last shot?" You know, because the $90/mo for boot camp I pay and the $350/mo for the medical weight loss program (aka phentermine pill mill) wasn't enough already. "I just think it's taking the easy way out for SOME people, not all. Like liposuction." Liposuction? Really??? FOH.

Wow you look amazing! How long ago did you have your sleeve done? We're the same height and nice been looking for pics of folks around the same starting weight to give me an idea of what I might be able to expect. ????

Well it turns out that Tran IS in-network and accepts my plan. I signed up for the seminar on the 11th. If you don't mind, could you share what steps you had to go through in the process and how long did it take from seminar to surgery day? I have one concern, because I recently moved here in 2014 and just hadn't found a PCP yet. I have records from my old one, but I'm nervous whatever new PCP I go to will give me a hard time about giving me a letter of medical necessity/clearance although I have a 41.5 BMI. I don't have any other health conditions (yet), but I'm just tired of always losing and gaining it all back. And now I'm seeing issues with joints, back pain, etc...it's just time. Anyways, if you could shed some light on the process you went through with Dr. Tran, I would really appreciate it. Thanks in advance!

Thanks, @@Chrystee! I saw that Howard has a program as well, I'd have to check to see if Tran takes Anthem BCBS. I see he's in the BCBS network, just not sure if he accepts my plan. I didn sign up for the seminar in a couple of weeks, tho.

Anyone familiar with Dr. Stephen J McKenna? His practice is in Frederick and he's affiliated with Holy Cross. I just went to his seminar this evening. I'm in Silver Spring, btw.