GoneFishin

Congrats! I just submitted my first (hopefully last) appeal to BCBS IL after being denied. I'm happy for you!....Dan.

Thank you. I called BCBS IL today. I told the "customer care" person that I was recording the conversation for accuracy. She pulled my record and explained that I had not completed the 6 mo. medically supervised, non surgical weight loss program to their satisfaction. I pointed out that I had done WeightWatchers for the required time and had lost 16 lbs. I was told that it must also be accompanied my records from my PCP showing that I had been counseled in exercise, calorie reduction, behavioral modification, etc. I pointed out that none of their info specified that. "Sorry, that's the way it is." Happily, my PCP's nurse is a fighter. She said "I can fix that." and said she would fax what they need tomorrow. Maybe 3/03/09 will still be my magic day! Thanks again. BTW, good results on your part. Way to go! Dan.

I have BC/BS of IL. Their requirements don't stipulate and weight loss during the 6 month program. In fact, here are their words: · It is expected that appropriate non-surgical treatment should have been attempted prior to surgical treatment of obesity Non-surgical treatment of morbid obesity appropriateness criteria: · Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 6 months, occurring within the twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program. [NOTE: The initial BMI at the beginning of a weight reduction program will be the “qualifying” BMI used to meet the BMI criteria for the definition of morbid obesity used in this policy.] · A program will be considered appropriate if it includes the following components: 1. Nutritional therapy, which may include medical nutrition therapy such as a very low calorie diet such as MediFast or OptiFast OR a recognized commercial diet-based weight loss program such as WeighWatchers, Jenny Craig, etc. 2. Behavior modification or behavioral health interventions. 3. Counseling and instruction on exercise and increased physical activity. 4. Pharmacologic therapy (as appropriate). 5. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health. Good luck...Dan.

Born and raised in Portland area. Moved here to Sequim WA from Sandy OR. Dan.

Good to hear from you again and that you are doing well. Seems like my 3/03 surgery is a long way off, but I hope to be well informed when it happens. I have real that post-op day 3 is the worst. Keep us informed. Dan.

YOU ARE MY HERO!!!! I get banded on 3/03and am more apprehensive about the pre and post op starvation cruelty, than the surgery itself! Myself, I don't post much, but I read just about every new post every day. I consider myself really fortunate to have so many friends here that I don't even know. I know that when my time comes, they will help me, as they will help you. Have a GREAT experience. I will join you soon.

I had my initial consultation with the surgeon as well as my psych evaluation last Wednesday. Now waiting for insurance approval, then meet with anesthatist, nutitionist and surgeon again before surgery. To be honest, I do have a bit of apprahention, but I am confdent in my medical staff and have heard great things about them. My journey has taken about a year to date, so I am ready. I certainly wish you well in getting better. You will find a lot of support here. Best wishes.

I know little, as I will not be banded until 3/03, but it seems to me you are entitled to be negative in this case. In my opinion, you have received unacceptable care. I encourage you to insist upon being treated respectfully. Are you in USA or a socialized medacine country?

It's called erosion. Google it. http://www.lapbandtalk.com/f78/lap-band-erosion-46721/

Chuck. Thank you for this info. It is EXACTLY what I need. My surgery date is 3/03 with Dr Hunter @ Virginia Mason. I will calendar the support meetings and plan to attend. How has attendance been? Thanks, Dan.

I have read about this, but my sergeon said he hasn't seen it with the new style bands. This is a growing concern to me as I am sceduled for surgery 3/03. I read one article that suggests 1/4 to 1/3 of all bands may need to be removed sooner or later. Get better, Mica.

Below is from BC/BS IL website. I finished my 6 mo. in Dec. 08 and psych evaluation and surgeon consultation tonorrow. I have a tentative surgery date of 3/03 with Dr. Hunter at Virginia Mason in Federal Way WA. subject to BC/BS IL approval. I am confident we have our ducks in a row and all will go smoothely. Hope this helps. Blue Cross and Blue Shield of IL require the following, do you have every thing listed below · At least a five-year history of Morbid Obesity supported by medical record documentation. AND · It is expected that appropriate non-surgical treatment should have been attempted prior to surgical treatment of obesity Non-surgical treatment of morbid obesity appropriateness criteria: · Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 6 months, occurring within the twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program. [NOTE: The initial BMI at the beginning of a weight reduction program will be the “qualifying” BMI used to meet the BMI criteria for the definition of morbid obesity used in this policy.] · A program will be considered appropriate if it includes the following components: 1. Nutritional therapy, which may include medical nutrition therapy such as a very low calorie diet such as MediFast or Optifast OR a recognized commercial diet-based weight loss program such as WeighWatchers, Jenny Craig, etc. 2. Behavior modification or behavioral health interventions. 3. Counseling and instruction on exercise and increased physical activity. 4. Pharmacologic therapy (as appropriate). 5. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health. Surgical Program for the treatment of morbid obesity documentation requirements: · Documentation that growth is completed. [Generally, growth is considered completed by 18 years of age or with documentation of completed bone growth.] · Evaluation by a licensed professional counselor, psychologist or psychiatrist, should be completed within the 12 months preceding the request for surgery. This evaluation should document: 1. The absence of significant psychopathology that would hinder the ability of an individual to understand the procedure and comply with medical/surgical recommendations. 2. Any psychological co-morbidities that are contributing to weight mismanagement or a diagnosed eating disorder. 3. Patient’s willingness to comply with preoperative and postoperative treatment plans.

With BC/BS IL, they use your original BMI before the 6 month non-surgical program.

I am just finishing my 6 months weight watchers as required by BC/BS IL. Initially, I would have liked to just have the surgery and get started losing, but the WW classes taught me a lot of behavioral modification. They knew from the onset why I was there and were very supportive. I feel the 6 months was not a wasted time. It will go quickly for you. I have psyche evaluation and initial consultation with the surgeon on 12/22. I am using Virginia Mason in Seattle. Good luck to both of us!

I just stumbled across your post, as I was looking for LifeMasters website and joined this forum. I"M BRAND NEW! Yes, I received the BCBS Il. info in the mail, BCBS called me and I did accept the program. Kind of a phone wellness program. You can call them @ 1-866-543-2053. Now, perhaps you can help me. I have been considering LapBand for some time. Spoke to my dr. about it yesterday. He recomended a dr and will arrange for a consultation. My question is does BCBS Il. participate in the cost of the surgery? That will probably determine whether I have it done locally or go abroad. Thanks, in advance, for all the help you can give me. Dan.