mem123

I was banded on July 14, I had terrible nausea that first and second day, mostly when I moved around. Gas pain was bad too for the first few days, it's just a little anoying now. I can't tell if I'm hungry or have gas most of the time! Port area hurts though. I'm off any pain pills, may take tylenol if I really have to do something. Who else woke up after surgery and thought, "What the #@* have I done to myself?!":w00t:

Niecey OMG! I though I would go crazy with the seemingly endless changing rules! I know exactly what you mean. You do the diet - then they want more. You have the co-morbids - that's not enough. When I finally thought I had it they said I had to be on TWO blood pressure pills, not one! I thought BCBS would give me a stroke before the surgery!!! I am so sorry they put you through this - but they have to keep their money (our money we've paid for years) as long as possible!

I think it was about one month. Although, I called them to see what was happening and was told the surgery had been denied over the phone. The letter to me from BCBS took a couple more weeks. By then my Dr. had already filed an appeal. My BMI was between (37-35) over the six months or more I was meeting with my PCP; but I had other co-morbidities. Call them if you want an update, I did regularly! They may have got fed-up with me and just said no to annoy me! I have read on here though that some people get a reply within days. My surgeons's office say 4-6weeks though. Good luck!

I was banded July 14th - and all I can say is no way would I have been able to go to class the next day.

Neicey, yes I did get approved. I had surgery 7/14. I was denied surgery the first time and like you, it took a while to get that denial. Then I appealed. Basically I sent a letter through their online site telling them how I complied with their rules, which were not specifically clear to me. I actually sent two online claims I think. Also, my surgeons office appealed the denial immediately it was received, I am sure that is what did it. After about a month I got a call from the Dr.'s office telling me that I had been approved. If you really want the surgery and think you should be approved go ahead and appeal their decision, ask your Dr. (pcp or surgeon) to appeal on your behalf also. Make sure you are appealing to the right location. e.g., I am in TN where my claims are processed, but my insurance's head office for disputes is in Ca., I actually have BCBS of Ca., for some reason. My pcp told me to send my letter registered mail to the dispute location as they seem to take it more seriously, that's what she has noticed. I didn't though, just online as I said. Good Luck:cool2:

My surgery date is July 14th - it'll be almost a year since I first contacted the dr's office! Dr. Virginia McGrath-Weaver?Memphis is my surgeon. I have Anthem BCBS of California although I am in Tn. All of my insurance goes through the Tn office and I have had to call California several times to resubmit something that Tn denied. BCBS have many plans though. I know it was hard for me to even find exactly what was in their policy regarding bariatric surgery. I actually followed a link through a previous message in the insurance section of this site to see what BCBS required. I could never seem to get out of them what they required to allow the surgery. Have you actually looked at policy documentation regarding this surgery? I guess some people have insurance that may stipulate no bariatric surgery. Seems immoral to me - over-ruling a physician. Still, if I was you I'd try to appeal the decision, find your insurance's appeal process and see if you can get your Dr.'s office involved. Look up on this site if any other BCBS/TN people have been approved for the surgery and what they had to do. My pcp told me she had several other patients with BCBS who have had the surgery. I am a very cynical person when it comes to insurance, I believe some of them turn down anything to see what they can get away with and for how long! And remember, I haven't had mine yet - they may refuse to pay after the fact! God forbid! I truly wish you the best of luck.

I have BCBS. I was denied the surgery too back in February/March. My surgeon appealed the decision, so did I (through the web-site). They changed their minds and are now allowing the surgery. I have all the same medical conditions you stated. I started this journey last August, did 6 months with my pcp weighing in each month. I was devastated when they turned me down, but the center I am dealing with really helped with the insurance. I suggest you file an appeal. I don't know what kind of BC you have, I have Anthem of Ca., although it it processed in TN where I live. However, the appeals go direct to the California office and it is them who reversed the decision. I also visited the BCBS website, filled out the "personal heath" forms, which of course told me all about my mortality rate (weight, BP, Cholest.,etc.); that in turn lead me to THEIR weight loss suggestions including surgery. I specified this in my letter of appeal. BCBS told me the procedure was acceptable for 40BMI or 35BMI and two other conditions related to the weight. I stated That THEY say I'm in need of weight loss and bariatric surgery is an accepted method according to their website/webMD. Anyway, the point is, appeal a couple of times at least before you go in to debt. Good luck.

I had cigna then switched to Anthem BCBS/Ca, Jan 1st 2008. They have driven me crazy! I did my 6 months (more actually) prior to getting BCBS. I called them before I went to my first apt., they told me the surgery was covered, and in fact, they would never question a doctor's request for surgery - whatever! I have since phoned three times to ask the policy specific to bariatric surgery, I got the same response, just "doctor's orders." Stupid me, I'm thinking maybe this co. is different from my last insurance. I went ahead with all the pre-op apts., cardiac check, upper GI, sleep study, nut. apts, psych eval, the works. Guess what? I was turned down flat. I was (am) in the same boat as you, pre-diabetic, just below 40BMI, high bp, depression, family history, high chol/tri, the works. They refused me because I am not on death's door yet. I was told if I was taking 2 bp pills instead of just one, I could be approved! It seems there is nothing consistant in the info given to their clients. It depends where you are and who answers the phone at that time. If I was 40bmi or above, the same. But I'd lost weight with the 8 months I've dieted. I'm still 38bmi. I have read their actually policy through a thread from this site (bcbs wouldn't ever specifically tell me their policy). I guess I just have to wait until I'm fully diebetic, or whatever else might satisfy them. It just makes no sense at all. They paid for all the pre-op visits, surely this is preventative treatment. Anyway, I have filed an appeal - which they will not verify they have received! I've called emailed 5 times to ask for verification. I will probably file another appeal just in case they say they didn't receive my first one within 30 days! I guess I'm ranting because I'm just so down about the whole effort. Wish everyone else better luck. There are positive stories out there.