venzwife

Grr... I got a denial letter today in the mail from BCBS of AL, but it was under my primary contract, which doesn't cover WLS (has an exclusion in the policy). I have two insurances, but my secondary is the one that covers it, not my primary. Dr. Schmitt's office submitted it to the wrong contract. This is a big confusing mess, but my husband works for Blue Cross, and tried to explain it to me. For billing purposes, they have to submit to my primary, and after the charge is denied, then the secondary pays. But for pre-determination purposes, they have to submit it to the contract that is going to pay out. Dr. Schmitt's office filed it last Friday, so I guess I lost a week. I'll have to get them to re-file tomorrow, I guess. How dissappointing!! What's so wierd is the letter was worded in a way that sounded like I didn't meet medical criteria: It was denied the same day as it was submitted, Friday. My hubby said all of BCBS was closed on friday (except Customer Service), so it must have been electronically submitted. If your contract doesn't have benefits, it automatically rejects it. I hate insurance!! **Frustrated**

Congrats Crimson Tide! I had looked into Mexico too, as an option in case I got denied by insurance, but I was worried about where to go for fills. Have you found a fill doctor that you are going to use here in the US? Other than FillCenter USA in Roswell, GA, I wasn't sure where else to go.

My co-worker wants the lap-band, but when she checked with her insurance (BCBS of AL, Blount County Sheriff Dept), it covers WLS, but only at 50%. Do any of you have an idea of how much that might be? Or even better, does anyone else have this coverage and might have an EOB we could see?

Did anyone else who submitted pictures as their evidence of weight history have to write a personal letter to BCBS stating why they haven't been to the doctor in 3 years? I told the new insurance girl I was using pictures as my evidence, and she said that she would use pictures only if I had exhausted all efforts to get records from the doctors I had seen. I told her I didn't have any records because I avoided doctors like the plague the last several years. She responded back that I still needed to see if I could find any records because BCBS is being strict about the pictures they send in. I told her there aren't any records to be gotten, again. She then responded with "you haven't seen any doctors in 05, 06 or 07?" I told her no. Then she said that she needed a written letter from me addressed to BCBS stating why I haven't been to the doctor in 3 years. This is NOT a requirement (my husband works for BCBS and confirmed this), but Dr. Schmitt's office said they needed it. Personally, I don't think it's anyone's business why I haven't been to the doctor in 3 years. I'll write the letter and turn it in - that's not really the point. I just got this vibe from her that she did not believe me, even when I told her multiple times, and didn't want to submit the pictures. Anybody else have to write this letter to go with their pictures?

PANIC!! I just read on another post that BCBS of Alabama is no longer accepting photographs as proof of weight history. Has anyone else heard this? I am only one visit away from finishing my 6 month diet, and I am planning to use photographs as my evidence.

I have a question on the 6 month diet. My weigh-ins have fallen around the 28th/29th of the month for my last 5 visits. I have two more to go, but I am in a dilema on this month. Since there are only 28 days in the month, I either have to go less than 30 days from my last visit, or skip the month of February, and go at the first of March. I am really paranoid about BCBS pulling something stupid and not counting this weigh-in. What would ya'll do? As of right now, I made my appointment for March 2nd. My doctor is on vacation the 25th - 27th, so the only other option I have is the 24th. Should I do the 24th or the 2nd? :tongue2:

Hi everyone, I had my appointment with Dr. Schmitt's office last November 11th, and at the end of this month I'll be 1/2 way through the 6 month diet requirement with BCBS. I felt compelled to post, given the subject matter of the last couple pages. I've gained 7 lbs since starting my diet, and I was really worried about not getting approved. :-( I think some of it was water weight, but I KNOW I will gain this month, given the time of year and all the food that is here around the office. It seems I always gain about 15 lbs between October 31st and January 1st due to "grazing". LOL!! Anyhoo, a question I had was about your first appointment with Dr. Schmitt's office. Did y'all actually get to see Dr. Schmitt or Miles? I got there, they took my $$, then I sat in the waiting room until the girl called me back & took my weight/height. Then she escorted me to a room where a nurse came and talked to me about the risks & life changes involved with getting the band, and asked if I understood everying & if I had any questions. Afterwards, I was called into the insurance girl's office (not Neomi, but another girl), where she went over my insurance requirements & coverages. After she was done & gave me some paperwork, etc, she said I was free to leave. I asked her if I was supposed to see Dr. Schmitt. She said no, but that I could if I wanted to. I went ahead and left because I didn't have any questions that they hadn't already answered, or that I didn't get in the seminar/support group/this board. I just thought it was kinda wierd that I didn't get to see him, especially after paying the money for the consult. I guess I won't see him until the pre-op appointment? Oh...and I forgot to add...turns out I am shorter than I thought I was! I haven't been measured since I was in middle school, or the beginning of high school, and I had always kinda just estimated my height based on what relatives say they are & where I fall against them. I thought I was 5'5", and it turns out I am 5'3.5"!

Well I guess we all just missed each other! :-) Maybe nextime we should all post pictures of ourselves on the thread so we can recognize each other. You bandsters would have to post pictures regularly so we could recognize your shrinking faces! :-)

Hi alabamagirl1975! I saw you at the seminar & meeting but I didn't realize it was you until I got home and read your post. You were the one who asked about the Fibromyalgia, right? I was towards the front (2nd & 3rd row. I was the blonde (I had my hair pulled back in a clip) with the multi-colored peach & brown silky shirt and jeans. My husband was with me and he had on a red Georgia hat & grey shirt. I was the one that asked Dr. Schmitt about taking pills after the band. I am psyched after that seminar! I have an appointment with Dr. Maddux on Wednesday to start my 6 month diet, and my appointment with Dr. Schmitt is November 11th. I'm going to call and schedule my sleep study on Monday.

I'm hoping he will want to stay. I would love for him to get the band too, but he's not ready yet (I don't think), and I don't think BCBS will cover his. His BMI is has been in a 35-39 range for the past 3-5 years, and he has sleep apnea, but I don't think it is severe enough. (stop breathing 50+ times an hour is I think what you are supposed to have, and his isn't that bad) Poor thing has hypothyroidism too, which is being treated with synthroid, but I still think it makes him lose slower than he should when he tries.

I'm going to the seminar, but not sure about the support meeting afterwards. I would love to stay, I'm going to be bringing my husband to the seminar, and I think he would be chewing through walls if he had to stay all the way through the support group meeting. How long do the support meeting typically last?

Thanks y'all! What a wealth of information you all are. :-) savedbygrace, I'm glad to know that you were able to lose a little bit in the 6 mos diet and still be approved. I was REALLY worried about that. I have about 9-10 lbs leeway to play with and still be above the 40 BMI. I am MISERABLE right now, and didn't know if I would be able to maintain exactly at that mark without either gaining (which I didn't want to do), or losing, which I was scared of doing. I'm going to try and maintain, but if I lose 5-ish, it's good to know I will still be okay. Can you go and have a sleep study done BEFORE your meeting with Dr. Miles/Schmitt? Do you tell them you are trying to get a lap band, or do you need to be referred from anyone? I'd be happy to go ahead and get that out of the way, but I want to make sure I don't do it the wrong way & have to do it over again. My husband has sleep apnea, and I would like to go to his doctor. Thanks!! :thumbup:

Alabamagirl1975, I didn't realize we had to have an EGD and Cardio test!? I guess that a Schmitt/Miles requirement and not BCBS. How much does that cost? I would love to get all of this stuff taken care of during the 6mos diet, but if I don't get approved through BCBS, I'd hate to have to pay for all of these tests out of pocket. Thank you ALL for your help! Y'all are wonderful & have answered so many of my questions! I hope I'm not bugging you if I have more down the road.

Thanks alabamagirl1975! I'll give her a call. Question...insurance doesn't cover the doctor's visits for a supervised weight loss program does it? How much did ya'll end up paying in doctor's fees for that?

Okay....I just read the post by savedbygrace that says they won't do it at their office. Does anyone have a doctor they can recommend to do the diet?

Thanks! I'm looking forward to the seminar. I can't wait to get this process started! I don't have a PCP that I can go through. I've only just gone to the gyno on a regular basis, and don't feel comfortable going through his office. What doctor do you go to? Are they local in Birmingham? I'd love to switch to a PCP that is pro-band. I'd love to go to a doctor instead of WW so I don't have to pay so much to weigh in EVERY WEEK. Especially if I don't plan on losing a whole lot. I have 5-10 lbs I can play around with, but I don't want to run the risk of dropping below 40 BMI. Do you know if they will do it at their office, or does it have to be done by an outside doctor?

Hi everyone. I thought I'd say hello. I have been reading this thread when I was researching the band and trying to decide which doctor to go with. I think have decided on Dr. Miles or Schmitt, and I am going to the seminar this Saturday. Can anyone tell me what to expect AFTER the seminar? Do I need to call them and make an appointment with the doctor, or what? I am going to TRY to get approved through BCBS of AL, but insurance approval always makes me nervous. I'll self-pay if they deny it. I know I have to do the 6 month diet, and I really hope they approve me. Right now my BMI is 42, so I am good there, but it wasn't quite that high the previous two years. I've Yo-yo'ed for the last decade (since high school). I had a BMI OVER 40 my senior year, and the lowest I've been able to get it was around 33 (which was in 2004 - lost weight for my wedding), but I krept back up there after that. My plan is going to be to try and submit dated pictures for the previous two years requirements. I have PLENTY of those. Ick. Its funny how I would get excited to find pictures that made me look fat! It's usually the opposite. Anyhoo...I thought I'd say hello and ask about the seminar. Did ya'll do your 6 month diet through their office, or did you do it through somewhere like Weight Watchers, etc?