Misha42000

Can anyone with Highmark BCBS of PA tell me their experience with insurance approval?

Thank you so much I did it!

Can you please tell me how to add the weight chart at the bottom?

I am two days post op and can't seem to take anything. My nausea is bad and I can only take sips of water so I'm not getting any protein in.

I just requested u on fb. My surgery is on Monday 6/12. I live in Md.

Please be honest and no negative comments. DID anyone cheat during their pre op liquid diet ?

Yes we can do this!!! Surgery is on 6/12 for us both

I agree it's a process and thank you

So I have Highmark BCBS and I have completed everything and had my pre-op appt with my surgeon this pat Monday 5/08/17. She said they would be submitting everything to my insurance for approval. Today is Friday and I found out surgical coordinator has been out sick all week (God bless her soul) but the wait is killing me. I'm so anxious and worried I may not get approved. Patient Selection Criteria for Adults The patient is morbidly obese and is at least 18 years of age. Morbid obesity is defined as a condition of consistent and uncontrollable weight gain that is characterized by a weight which is at least 100 lbs. or 100% over ideal weight or a BMI of at least 40 or a BMI of 35 with ANY ONE or more of the following comorbidities: Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of 3 anti-hypertensive agents of different classes); or Cardiovascular heart disease (with objective documentation by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, CT angiography, coronary angiography, heart failure or prior myocardial infarction); or Hyperlipidemia; or Diabetes mellitus type II; or Obstructive sleep apnea (OSA); or Obesity-hypoventilation syndrome (OHS); or Pickwickian syndrome ( a combination of OSA and OHS); or Nonalcoholic fatty liver disease (NAFLD); or Nonalcoholic steatohepatitis (NASH) Patients should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. However, there is a lack of evidence on the optimal timing, intensity and duration of nonsurgical attempts at weight loss, and whether a medical weight loss program immediately preceding surgery improves outcomes. The patient must complete a psychological evaluation performed by a licensed mental health care professional and be recommended for bariatric surgery. The patient's medical record documentation should indicate that all psychosocial issues have been identified and addressed; and Patient selection is a critical process requiring psychiatric evaluation and a multidisciplinary team approach. The member's understanding of the procedure and ability to participate and comply with life-long follow-up and the life-style changes (e.g., changes in dietary habits, and beginning an exercise program) are necessary to the success of the procedure. If the patient does not meet ALL of the patient selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. Procedure Codes 43644, 43770, 43775, 43843, 43845, 43846

Congrats! Way to Go

My surgery is in a week on 6/12 and I started at 262 and I'm about 226. I have learned a lot though this journey and I am continuing to learn more each day with the help and support from everyone here. If I could do my surgery tomorrow I would. I have embraced it. In the past my weight was like a yoyo I would lose then gain it back in a couple of months so I need this surgery.

Hows it going after surgery? I see u have lost a great amount of weight.

Thank you so much for ur honesty. I'm glad I wasn't the only one.

I'm confused how does it grow back?

Thanks Shellee7399 I luv u Chica

Thank you for sharing. I struggled but I'm back on track and surgery is in a week so I'm super excited!!!!!

Lol thanks, and I choose string cheese but I'm back on. My surgery is 6/12 can't wait

I asked for the first available date, but call your surgeon's office to let them know when you are ready and most likely they will tell you what dates are available. Good luck with everything and Congrats on ur approval

I appreciate it Joann thank you

Thank u Joann I appreciate it. I made a mistake of being honest and wish I could delete this post. Thank you for ur kind words

Thank you and I am back on track

Lol no I didn't but I had a moment of weakness....... I'm back on track though

First of all it was a question??????????? I think ur confused because I was straight to the point. Just in case you didn't know, "Never ask a question with a QUESTION!!!!!!!!!! Psycho.....

It is a life changing surgery but the reality is if some of us were able to eat right and exercise we wouldn't be overweight, while others like myself struggle everyday it's not as easy for me which is why I am having the surgery. I'm happy that you don't know that struggle. My surgery is on 6/12 and yes I have cheated with string cheese and some green olives.

I have Highmark BCBS and hey stopped doing the 6 month nut requirement in dec 2016. Look at ur medical policy online if u registered with ur insurance and it will tell u the policy requirements.