catseye

Quoting myself as an update... I got my approval today, two weeks from submitting initial paperwork, even though she had to refax my weight history because they couldn't read some of it. *bounce* - jen

What would Illinois have to do with it? All approval is based on your insurance company policies, not where you live. - jen

And if he won't, you have a legal right to copies of all your medical records. Your doctor cannot withhold them from you. Edited:here's a fact sheet on medical records wrt HIPAA and your rights: Medical Privacy: Frequently Asked Questions - jen

There's a duplicate post on this. http://www.lapbandtalk.com/f8/anyone-bc-bs-illinois-ever-approved-47092/ :coolgleamA: - jen

Sorry for the terrible formatting, I have no idea why linebreaks keep disappearing.. - jen

I'll be honest, this is why you should always check your own benefits. When I called BCBS seven months ago, they directed me to the BCBSIL medical policies, which are planwide afaik. I'm not sure if this link will work for you since you had to hit accept and jump through hoops to get to it: BCBSIL/Provider Medical Policies on Fyiblue If that doesn't work, go to the bcbs site, go to provider library, then medical policies, and search for obesity. Surgery for Morbid Obesity should be the first one that shows up. At some point you have to hit a yes-accept which is why I"m not sure if the link will work for you. It sucks that you got misinformation from your surgeon's office, but you should probably always double check stuff like that on your own. I'll be honest with you though? The six months dieting (through a nutritionist who knew I was preparing for lap band and not just regular weight loss) was some of the most valuable time for me to learn and start to assimilate the changes I'll have to make. Good luck. - jen

My coworker submitted to BCBSIL about three weeks ago and got her approval a week ago. (we found out halfway through our pre-surgical dieting period that we were both trying to lapband approval, and were going to the same surgeon's office and the same nutritionist. small world) She had only her six month dieting history, psych eval, and five years of weight records (no co-morbidites). My package (which contained the same, pretty much) was sent off yesterday. I'm supposed to hear something within 15 days. Both the billing office at my surgeon's and the nutritionist said that they are seeing more and faster BCBSIL approvals recently. Speculation is that first-time denials and then having to go through the appeal process was costing them too much. Just sitting here keeping my fingers crossed that I have the same kind of fast turnaround that my coworker did! - jen

I'm not from there area, but there's a great Yahoo group for DFW Bandsters: DFWBandsters : DFW Bandsters They seem a pretty tight group, and I think they get together for luncheons and other stuff. - jen

Through this whole post this is what I was thinking. Honestly? If MY husband (whom I love dearly, don't get me wrong) decided that *I* needed WLS and that HE was going to drive the process by posting here? Sorry, but F that. This is my journey, for me. My whole life I've had people (my mom, mostly) try to take charge of me losing weight. Yeah, it was because those people love me and want me to be healthy, but I'm also pretty resentful of people who take over this way. The 'come to jesus' talk that the OP mentions would have pissed me off to no end, and I don't think I'm necessarily the only overweight person to feel that way. I KNOW I'm overweight. I know it's unhealthy and I need to do something about it. But having others decide what's best for me just bothers me. Just my $.02. Maybe his wife is more gung-ho than she comes off, but remember that this band is a tool, and without working on eating habits beforehand it's not going to be a very useful one. Has she visited with a licensed dietitian, and maybe a psychologist to work with any food issues? You lose the commercialism of weight watchers and still get good information. - jen

This is mostly what my nutritionist visits were like. Mine didn't give me a diet to follow, but she looked at my food logs and we worked on a certain number of changes each month -- changes that I was going to HAVE to make once I'm banded. Things like waiting 30 minutes before and after eating to drink, eliminating carbonation, eating three small meals and eating them slowly -- heck, just adding breakfast to my day took something like two months for me to get in the habit of. (I used to skip breakfast, eat a giant lunch, nibble all afternoon, and have a reasonable dinner. No more.) And we won't even talk about how long it's taken me to really get in the habit of working out 3x a week. Instead of thinking of this as just another diet, think of this as getting these habits in place for after banding. It takes time to get into habits. Why not commit to them now? As I had my last visit yesterday, the nurse overseeing my visits (I actually saw a nutritionist, a behavioral psychologist, and a nurse for each visit) was praising me for the work I'd already done towards making banding the right choice for me. She was saying that there would be people in my surgical office sessions who had never even heard of a lot of the 'rules' we'll have to live by once we have the surgery, and how I'd have so much to contribute to these meetings because I'd already done a lot of the work. I'll be honest, I didn't lose a hugely significant amount of weight during this process -- about 20 pounds. But the things I've learned and taught myself are only going to make the rest of the process easier. - jen

Wow. Things are getting close. So I had my last visit with my pre-approval nutritionist team yesterday. Five more pounds down, for a total of 20 since January (more or less on the timeframe. I didn't really get into the grove of things before then, tbh). Actually spot-on for what the nurse told me would be a good loss for the time period/approval. Next Tuesday is my psych evaluation. I have seven years of weight history from my gynecologist's office. I have six or so months of other dieting records from another doctor along with a bunch of test results from 18 months or so ago that should be faxed over today. One annoyance I'm facing is that I went to see my primary care doctor two weeks ago (for back pain). I asked for a letter -- they said they'd write it and mail it. After giving them a full week, this Monday I called their office asking where it was. Today they called and left me a message saying that he won't write a letter of recommendation until he sees me for a full physical. Now, I don't mind going in for a physical. What I do mind is having to wait two weeks to find out I even needed one. So, I left them a message today (they're closed Wednesday afternoons I guess, lucky them) saying that I'd like a copy of my full medical chart and to let me know when I could pick it up. Technically I HAVE all the records I need, so anything from them was superfluous anyway, but I'm still annoyed at their lack of follow up. Grr. But I digress. I have all the above charts. Once I have the psych evaluation on Tuesday and drop off the last of my records, we make sure everything is in order and submit for insurance approval. Interestingly, one of the things that the nurse said yesterday was that BCBS-IL is getting better about approving on the first go-round, because it was costing them too much to deny the first time and then approve on the resubmission. So, that's potentially really good. In the meantime, I have a pulmonary clearance appointment set up on May 16. Who knows what that entails. Anyway, all of a sudden it's like a landslide speeding up towards the end. Who knew that last October when I lamented the amount of time that I needed to spend doing six months of pre-approval dieting that it would be going so fast at the end! I'm bouncing between nervous and excited and absolutely freaked out. But I'm guessing it's the same stuff almost everyone else here went through, too. Anyway, I just needed to share with people who actually get it. - jen

I think you should have followed your doctor's orders the whole time. This is a major surgical process leading up to a major lifechange. Why would you even cheat during this time? Just MHO. - jen

This is probably because a psych eval would fall under mental health benefits for your insurance company, which is usually different than your medical benefits. That said, mine's $325 (in chicagoland) and will be paid by insurance but which falls under my $500 deductible, so I"ll be paying it out of pocket. - jen

I was very worried about the doctor's notes for these visits because I didn't want to have to do it over again if I already had to wait six months for approval. I decided to go to a nutrition center that the surgeon's office works with on a regular basis because they would know what insurance companies expected in terms of notes for surgery approval. Each of my monthly visits is with three specialists and lasts about two hours (a nurse practitioner to oversee it, a psychologist, and a nutritionist). I've also got food and exercise logs that I go over with each one of them (we talk about different things in each case). I got 7 years of weight and blood pressure history from my gyne's office last week (copies of the notes) which should cover that requirement. I don't really have any comorbidities (my blood pressure has gone back down to normal since regular diet and exercise) so my primary care doctor is just writing a letter of support. I really only see him when I'm 'sick' anyway. I should be submitting to BCBSIL in about two weeks (my psych eval is on the 22nd). I've got my fingers tightly crossed that it will all go well.

Oh, I'm seeing Dr. Rantis too. How'd you like him through the whole process? I was impressed iwth him at my seminar and at my consult. Yeah, I was a little annoyed that the psychologist visit will be AFTER my six month weigh in. Oh well. - jen

I'm in Chicagoland, so I'm using the Kane Center through Alexian Brothers hospital here -- it's NW of the city. My sister lives up in Minnesota -- she's in Waconia, which is out near Eden Prairie, ish. Good luck on your wedding and the whole process! - jen

I haven't been banded yet, but I'm in the middle of my fifth month of dieting for BCBS-IL. Here's how mine's been handled and what my surgeon's office said: - after my fifth nutritionist visit (five months) the nutritionist's office sent preliminary notes to the surgeon's office. - The surgeon's office called me, and told me to start collecting my other doctor's records (five years of weight loss history, any co-morbidities) in the next month. We also set up a date for my psych eval, required by BCBS. - after my sixth visit, final notes from the nutrition office will go to the surgeon's office. - surgeon's office said they should have the psych eval notes within a day or so of the appointment. - surgeon's office said it generally takes 2-4 weeks for BCBS to hand down approval, and that surgery is generally scheduled within a month of approval. Hope this helps. Good luck! The six months has gone by more quickly than I could ever imagine... - jen

This. Except during my six insruance-mandated meetings, I met with a whole diet/health team: nutritionist, nurse practitioner, and a behavioral psychologist. I honestly think meeting with the behavioral psychologist has helped more than anything. We did some cognitive therapy to address some of my food/eating/emotional issues.

I'm in the Chicago area too -- NW suburbs. I'm using the Kane Center in Arlington Heights. I'm still waiting to submit for approval this month, though.

Hi everyone - Introductions always feel weird, but I suppose I can't jump into spazzing out at you. My name is jen. I'm 34 and.. well, I'm fat. I've been overweight since I was a kid. I've lost 50 pounds more times than I can count, and gained it all back every time. At my heaviest, I was 260 (I'm 5'2.5"). Right now I'm struggling to get under 240. Mid-last year, my blood pressure started to creep up, and my dad was diagnosed with Type 2 diabetes. That's what I see in my future, and I don't like it. I started looking into the lap band last year, and now I'm on my 5-1/2 month of my 6 month doctor-supervised dieting that my insurance company (BCBSIL) requires for approval. I have my final pre-insurance weigh-in in about two weeks, and go for my psych evaluation on the 22nd of April. And I've pretty much been reading everything I can get my hands on about people's experiences with the band. I've lost weight quite slowly (well, slowly compared to how I'd lose weight if I'd get serious about following the current 'fad' -- be it low carb, low fat, whatever) while seeing the nutritionist, but I did make a lot of positive changes that I've never done before -- things like get used to eating three meals a day instead of one or two giant ones (adding Breakfast was really, really hard for me), eating more slowly, not drinking with meals -- all the things I'm going to have to do once I'm banded, anyway. I've also been exercising three times a week for the past four months with a coworker who is also planning to be banded around the same time (we didn't find out till we were both about halfway through our six months insurance approval dieting time period, which is kind of hysterical. We're even both going to the same surgical center, though different surgeons). And now that I'm getting close to the time when I submit for insurance approval, I admit I'm freaking out a little about how much everything is going to change. Even though I KNOW I need to do something, now that it's really this close.. I'm both nervous and excited and overwhelmed. And it doesn't help that a friend of my sister-in-law has apparently had a terrible experience with her band (though I also hear that she got so upset at her surgeon that she had the surgery and then didn't follow up for a year and a half, so I'm not sure how much to take her "advice" about it) -- and who, now, is apparently only eating 600 calories a day, is losing her hair by the fistful, and who gets so hungry that she shakes. Of course, now my sister in law is very concerned about me going through this, as well... but to me, that experience doesn't sound like the norm of what I've read, both here and in many other places. She really wants me to call her and have a one-on-one conversation, but I'm kind of shying away from it, because I don't want to let one overly negative situation have too much weight. Anyway, I've been lurking here since I started the dieting process, but figured I'd come out and say hi.