Niecey

Well I finally got my answer. I was denied!! "Office notes documenting supervised weight loss were requested but not provided. Criteria for medical necessity has not been met." If you say you didn't get the documents you needed then how can you determine it's not medically necessary??? I have all the paperwork the insurance received 3 times (so they could prolong it 30 days each time) and it's all here. I could just cry. I am so ready to get this surgery. Both of my sister-in-laws got the surgery and they look great. Everyday I'm doing the treadmill, trying to watch what I eat and nothing, no results unless I almost starve myself and then I'm so hungry. So now I am going to appeal it. I did find a 19 page long document on the Blue Cross/Blue Shield website on appealing, greivances, etc. It actually goes up to Level 5 and after that you go to Federal Court. Wow, do I have a long road ahead of me? I am not going to give up. Insurance companies should not be deciding the fate of our life. If my doctor says it's medical neccesary and would provent my start of diabetes then I should be able to get this procedure. They did not deny me from having a tubal ligation and that had nothing to do with helping my health in the long run. I know I could just get it and pay out of pocket but we also need a new car. I don't want to put my family in $30K+ debt. Wish me luck!! Neicey

I have not posted in a while too because my insurance is dragging their feet. I have BCBS of New Jersey. My whole process started in Sept of 2007. I did my 6 month diet and I'm borderline diabetic. Everything was processed in March then in April they came back and said they needed more info about the 6 month diet. Everytime they ask for something they say it's another 30 business days. So by the end of May they said it was still being reviewed. I asked why it was taking so long and called every other day. They said they would have to send an email and that response would take another 10 business days. I asked for a 48 hour expedided review and still no response. My DH talked to his HR person who sent an email asking what the hold up was and that this was the 2nd time they did this and they needed them to get on it. Dr. Morton's office, Amy, has been wonderful about calling everyday. Amy now has an actual person she can talk to and this lady has asked for additional info showing I have dieted for years and what diets I have been on. Amy explained that this was not in the original request but the letter from my doctor in Sept of 2007 already stated all the diets I had been on and I have had my primary doctor for the past 7 years. She was asked that it be resubmitted, which she did and that was a week ago. Now BCBS of New Jersey is not returning her calls. How can insurance companies get away with this? I have not even been denied so I can appeal it. My guess is they have no reason to deny me so all they can do is string it along hoping I go away. Meanwhile I know that I am getting closer to needing to be on insulin. My dad died from diabetes. I don't want to start that process. Isn't it a known fact that the lap band helps get rid of diabetes? Wouldn't someone at BCBS of New Jersey realize that in the long run the lap band will be cheaper on them? Sorry to rant but this seems so wrong that they can get away with this. Thanx for listening. Denise

Amy called today. My insurance will still take 6-8 weeks for the final decision. How frustrating. So hopefully I will know by the end of April. She said if I get approval they immediately set a surgery date and I come in and find out what all I need to do. One thing being a 2 week pre-op diet of 2 protein drinks and 1 frozen meal. What is a frozen meal? I'm scared to death because I cannot imagine only eating 2 drinks and a snack per day. If I could do that I wouldn't be fat to begin with. Oh well I will just have to pysch myself up.

Brock good luck with everything. Let me know if Dr. Morton has you do a liquid diet before you have surgery or anything else he has you do. Baboo when is the support group held? Denise

What support groups are out there in Nashville?

did Dr. Morton have you to go on a diet before surgery? If so what and what type of diet after surgery? denise

I went to Dr. Morton's office (Southern Hills at that time) in October. My insurance company denied lapband and said I needed to see my primary care physician for 6 months and get a physch test first. Dr. Morton's office warned me of this so I started right away. The physch test went fine. My last "weigh in" was Friday. I have actually gained weight since I started because I also quit smoking. It didn't make much sense to lose the weight to live longer but continue to smoke. I hope gaining the weight does not give the insurance company a reason to deny me. So now I wait for the insurance company to decide. Hopefully they tell me right away, I'm eager to get this started. I have not heard from anyone but I am wondering if Dr. Morton has you go on a diet before the procedure or anything like a liquid diet before. Denise

Dr. Morton's office in Southern Hills has closed and he is only at Baptist.

I get bored doing exercise too. We have a treadmill and I have to record programs like Biggest Loser to inspire me as I walk and it helps keep my mind on something else. I'm still waiting on insurance but going to Dr. Morton. Did he have you do any preop diet before surgery?

I have only heard good things about him. I am still going through my 6 months of "dieting". Friday is my last appointment. I've already taken the pysch test now just have to wait for the insurance. I'm praying. Good luck.

Maybe he is at both because I am seeing him at Southern Hills.

Wendy, I am waiting on insurance approval but I am going to Dr. Morton too. I haven't seen him yet but I have 3 more months of "dieting" to satisfy insurance co. I'm keeping my fingers crossed. Do you like Dr. Morton? Niecey

Thanks for the advice. I have actually gained weight because I quit smoking. I was afraid I would get ready and the doc would not do the surgery if I smoked. I gained 15 pounds in the process. GREAT just what I needed. At least I have a good reason.