NicoleW8ing

I had the exact same situation. EXACT. THE THE F**KING TEE! I am approved now. 5 Month struggle to do so, but I got it. First off, it sounds like you're being denied because your BMI is over 50, is this correct? My policy had an exclusion for BMI over 50 as well. I am going to PM you now. I am approved. It was a struggle, but I was. I am a full time student, full time employee, and I sure as hell don't have the funds to pay for this surgery myself. My premium health insurance didn't want to cover it for some stupid exclusion, but I got around it. Alright... sorry for rant, PMing you now.

I don't say this enough. Thank you guys for being here. Thank you for asking questions and answering them with respect, dignity and sometimes the undesirable truth. My post count does not reflect the hours upon hours upon hours I spend reading.... thinking about posting... then searching and finding my answer. You all are wonderful and I really don't think I would have this surgery without this forum. :thumbup:

I can't resist replying to this thread. As in most really good arguments, the correct answer seems to be a compromise between both sides. I think, first and foremost, a Mexican doctor is not an option for those that do not plan for the follow up. Two months after your surgery, if you find out you have to drive four hours to get an adjustment and you simply do not have the funds to go back to Mexico... well, to be blunt, you done messed up. Investigate where you will get your follow up care before surgery and don't cry about Doctors not filling you or being stuck with no aftercare. MAKE A PLAN, CALL AROUND, THINK AHEAD. I hate the American health care system. HATE IT. However, I was born here, raised here, and will make due with what I have. Because of certain sue-happy individuals, Doctors pay an ASTRONOMICAL fee in malpractice insurance. My uncle has his own practice out of Pennsylvania and has never had a malpractice suit against him. His malpractice insurance runs about 18K per month. He's a GP, not a surgeon. This coupled with inflation and the overpriced hospital fees makes one expensive lap band surgery. Not to say an American doctor is desolate by any means, but they do not get even close to the whole 20K. Now, let's acknowledge the stereotype. Everything is cheaper in Mexico. Tiajuanan medical horror stories are rampant. This may or may not be the truth, and frankly, it doesn't matter. If the individual chooses and PLANS to have surgery by a REPUTABLE MEXICAN DOCTOR, more power to them. The error seems to be in the poor planning and hasteful decision making. Personally, I would never have surgery out of the country, purely because it took me two doctors and several years of background checking to choose a Doctor. My parents work in health care. I want to be near them and their familiar territory. I'm an anal person and I like to see my Doctor a lot. I complain about the 20 minute drive to my Doctor's office. I'm a worry freak. If something happens to my band, I want the Doctor that put it there to be responsible for it. Point being, surgery out of the country is not an option for me. Does this mean that all these people that had surgery in Mexico are liars? Or all fools that don't know what they're talking about? HELL, NO!!!! It was the RIGHT option for them and the CLEAREST path to a healthy lifestyle. Everyone is different. For such a DRAMATIC surgery, the individual has to weigh out their emotional needs. Evaluate these things. Evaluate your comfort levels. There is no RIGHT answer that anyone could give you. The RIGHT answer can only be found in your heart, mind, and wallet.

Call your insurance company and ask for a faxed or mailed copy of their WLS policy. Their policy will lay out the guidelines without you having to ask awkward questions. I went through it, though on the upper end, not the lower, and I am telling you it is WAY HARDER to get approved once you are denied than it is to take care of it and evaluate your options beforehand.

My doctor said no liquid diet for me. Yay? Lol... just clear liquids the day before, no reds or blues, and no aspirin.

Hey Guys! Thanks for your kind replies... Yeah, Jean, everyone seems to LOVE Dr. Enochs. He is doing my band and scheduled me for May 9th. He got me approved and taken care of and he is a TOTAL sweetheart. Love him to death. Dr. Moran... ugh... Seriously... if anyone reads this thread that is thinking of surgery, STAY AWAY! Everyone I know that has seen him thinks he is rude and his office staff is useless. I adore the girls at Dr. Enochs.

Please let me know what your doctor says. I am getting banded May 9th. I miss roller coasters. I haven't been able to ride for a year or two because the chest harness can't close over me anymore, or if it does, it's SUPER uncomfortable. So I just avoided the humiliation and didn't ride but Lord I miss it.

Grats, Whisper. Besides soreness, you're doing alright? Good to hear that your pumped up!

Whoa.... slow down. Breathe. I have seen many people feeling similarly for the first few weeks, as the recovery time seems to be the most emotionally trying. You are doing so wonderfully! You are following your Doctor's instructions... think of obesity as a disease. You are curing yourself right now. Every step in the right direction is bringing you towards better health. Plus, how great are you going to look once the weight is gone??? Slow down. Breathe. Try a different brand of unflavored whey Protein. Sprinkly a tablespoon into everything you eat so that you do not get a concentrated hit of smell or taste. You can do this. I really believe in you.

I was going to make a thread here with the same title. .... I am going in May 9th. I am TERRIFIED... not only of the "is this the right decision?" question but just general surgery jitters. We're all there honey.

Another thing to remember is that hospitals WILL work you. They really don't care as long as you pay anything. $10 a month is still something, you know? This has been my experience, anyway. Moving on to the deductible.... I have a $1000 deductible on my insurance policy, but due to all the appointments and procedures that I have had pre-op, I have met my deductible, so no payment for surgery. Point being, those little $40 copays add up REALLY quick to a deductible, should that be your scenario.

I have Blue Cross Blue Shield of NC... they are covering 100% of the surgery. (Got approval last week).

I was May 2nd, but due to a scheduling conflict (my mom is out of town the 2nd), we moved it to May 9th. I have no pre-op diet whatsoever. (Well, day before surgery just clear liquids) I am not really pigging out but I am not dieting either... Just kind of being normal I guess. We moved this past weekend so the surgery date being set hasn't really "hit home" for me yet. 5 months after I started the process... 90% of which was fighting with the insurance company.

Hey all... After 5 MONTHS to the day of fighting with the insurance companies and Doctors, I approved for Lap Band and have a confirmed surgery date of May 2nd at 7:15AM. My first consultation was January 2nd. After filtering through two different doctors, dropping weight to get under 50 BMI, and arguing with BCBS, I am approved. I am absolutely elated. I will be one of the first May bandsters, I imagine, as the first is a holiday. :tongue: Thank you all for your support, advice, and most of all friendship for this first part of the pre-op. I can't wait to join your ranks of BIG LOSERS after I drop my weight. :redface: <3, Nicole

May 2nd, 7:15.... am I the first May bandster? Lol lol lol... I second Magnificent Mays... :redface: Yay... I can't wait to experience it all with you guys!

I have BCBS... Here's the skinny on the 5 year. They like it a lot, but it doesn't necessarily have to be 5 CONSECUTIVE YEARS. If you can get 5 weights within the last 10-15 years, you should be fine. I was in a similar situation. Instead, I had my grandmother who works at a doctor's office a few states away just manufacture some weights for me. I know, immoral, but after dealing with BCBS for 4 months on this, I am none to happy with their morality standards. My struggle with BCBS has nothing to do with that weight history though, my BMI was above 50. Anywho, suffice to say it is no longer above 50. No one.... not the insurance company, the doctor, no one batted an eye at that 5 year weight history that was fudged for me. In any case, my doctor informed me that not many people have a 5 year CONSECUTIVE history. Remember, the more data you submit to the Insurance, the better off you are... so if you have 20 years off and on, then submit everything you got. Good luck and please let me know how it works.

I'm looking forward to the exact same things... getting banded next month.

I also have a lump on my breast right on my breastplate. My ob gyn said it's just a cyst. But, go get checked out anyway. YOU CAN NEVER BE TOO SAFE!!!!!

Congratulations to you!!!

:wink2:I look forward to the weight loss from the band so that I can have my formerly insatiable sex drive back. Now... I'm so blase about sex. I could take it or leave it. My fiance... well, let's just say his hard drive is filling up rapidly as a result. *shrug* When I am in the mood, he doesn't care whether I am drunk, frizzy-haired, or in my "fat clothes." Lol. Takes it when he can get it. But, I can definitely handle a 2-4 week wait after op :thumbup:

Truth be told, I don't want to deal with those people. I have another doctor lined up for my follow-ups. My mom works has worked in the hospital where he operates for a very long time. She prefers me to go under his knife than anyone else's. I am deathly afraid of doctors, surgeries, the whole deal. She trusts his slicing and dicing abilities more than the other doctor, though the other doctor has a MUCH better bed side manner and friendly support staff. I'll be switching after the operation. GAH! The idea of dealing with them for a lifetime after my surgery makes me cringe.

Hey all-- I am a LONG time reader, first time poster. This community answered many questions I was afraid to ask my doctor regarding my lap band, and I want to thank you all right now for just being so helpful and communicative. I am 23. Right now, I am 5'8" and around 350 *gasp* I finished my Pre-Op work up through Dr. Moran in Raleigh, NC, for those of you that are familiar. Saw the cardiologist, the nutritionist, the psychiatrist, got the blood gas, the chest xray, the blood work. I am good to go! They set my surgery date for March 19. Now, my Doctor is telling me that Blue Cross Blue Shield will deny me for lap band as my BMI is greater than 50 and only approve me for gastric bypass. I am horrified beyond comprehension of gastric bypass and am literally panicking here thinking about the remote possibility of it. I was very comfortable with lap band. Has anyone had a similar situation with Blue Cross Blue Shield? Other insurance providers? Has anyone had success or failure with an appeals process with insurance for these reasons? Has anyone been so scared of gastric bypass they'd rather eat celery sticks for the rest of their life than move on to a normal, satisfying but controlled life with lap band? Gah.... any help, experience, or advice is appreciated. Thanks people, and have a great day. :tongue2:

Hey guys-- Again, thank you for your warm wishes, your sharing, your experience, your time, and your support. I love this forum so much. Once I know everything for sure, I am going to create a thread in the larger weight loss forum so those of you with higher BMI and BCBS know what to do... Here's my log of this morning: Calling BCBSNC's Utilization Management team (the people who do the denials and approvals) revealed that I did have all my paperwork correct and the only basis I was denied on was the BMI. Good to know... they also said that I probably would not need to appeal, that a call from the doctor to the insurance company's doctor (they call it a peer to peer review) would be all I needed to get it most likely approved. It seems that my problem is not with my doctor specifically OR the insurance company. It is my doctor's support staff. Unfortunately, my doctor's support staff was BEYOND unhelpful this morning. They simply told me that I could contact Capital One for financing. I considered this obscene. They told me my doctor was too busy to deal with the insurance company. Considering my surgery is being billed for $23,700, I find it hard to believe he's far too busy for 15 minutes of my time. I emailed him. He called me within 45 minutes and told me he would be contacting the Medical Review Coordinator and BCBS today. This is a step in the right direction and it keeps me out of the appeals process so I do not have to lose my March 19th surgery date. I'll keep y'all posted. As soon as I finish everything, whatever method I have to take to get this surgery approved, I'll be posting a guide so the next person does not have to deal with this. I've had 3 panic attacks in the last 48 hours, nursed through by Xanax and rest. Undue and completely unneeded stress. Love ya guys! Nicole

Hey all... So it happened. Blue Cross denied me. Through some careful manipulation, I got an appeal meeting for Monday morning. I am digging out everything I have, writing up an argument, etc. (see my thread here: http://www.lapbandtalk.com/f84/devastated-blue-cross-blue-shield-52974/ for the full story). Anywho, I am begging you all for a bit of help, as you all have had unique experiences in this area. I need data, studies, testimonials, ANYTHING, expressing the following: Risks of Gastric Bypass vs. Lap Band Success of Lap Band vs. Gastric Bypass (short term and long term) BMI restrictions and Lap Band Benefits of Lap Band in BMI's over 50. I am researching my own data and coming up with charts and such, but anything you guys could add so I can get approved by BCBSNC would be sooooo helpful. I plan to BOMBARD them with information. Thanks guys. Keep lookin hot!!!!!

Check on Blue Cross's requirements in your states for pre-op. If you don't have all the i's dotted and t's crossed, they'll deny you. Just go over it thoroughly and make sure you have everything, and I don't see why you shouldn't submit it on Day 1. For me, BCBS required a 5 year CONSECUTIVE weight history.