bklyn1984

I have BCBS Federal Standard Option and I am going through the same thing with my doctor's office. But when I called BCBS they gave me a number and said it was to an office that dealt with WLS so I called and it turned out to be one of the people who actually approves patients. She asked me how I got the number and what was the name of the operator. I told her that I did not ask since she helped me and there was no reason to take her name down. I figured since I had her on the phone I am going to ask what she looks for to approve patients. She said what is stated in the employees benefit guide and while it does not mention any documentation or co-morbid for BMI 40 and over which I am. She looks for a package from the surgeon that includes weight loss history (no time line was mentioned), diagnostic testing (Upper GI, sleep Study, Blood Work, etc...), and a Psychological exam. She gave me an example of what is not acceptable. She had two pieces of paper in a patient's file and she said that's not good enough and this patient's surgeon should know better. She also mentioned that once she approves it to go forward the file is sent to a management end for final approval. She told me that surgeons should be very familiar with their policies and that your file should contain a lot more than two pages. I have a cardiology test and a sleep study to go through. Once they are done and the doctors reports are sent to the surgeon that should be it I hope . My doctor will not schedule surgery until approval has been received and I am okay with this. I want no one to come back to me and say that I did not have their approval even though they said they did not require it.

Hello I am also new to this site :thumbup: I live in NJ and the hospital I hope to have my surgery in (Virtua) has a pre-op and post-op program that I belong to. I am in pre-op getting all of the necessary information together for the insurance company. I go twice a month to a support group, nutrition classes, I met with the behavioral therapist, I meet with a nurse, I paid extra for a personal trainer since there's also a gym, I am on a 1600 calorie plan based on my current weight, and they follow you one year post-op. While I paid money out of pocket for this I believe that it is truly worth it. It better prepares you for what to expect pre and post-op. They are also helping me get all of my information together for the surgeon. I have also heard that patients who were told to lose weight prior to surgery have gone to weight watchers and began exercising. If you were told by your doctor to lose weight prior to surgery you may also want to see if your insurance covers nutritionists and perhaps they can help you get started. I would also ask your doctor at your next visit if he/she has an aftercare program with support or knows of any. Look at the FAQs on this website Frequently Asked Questions (NEW!) - Lap Band Surgery and Lap Band Discussion Forum or http://www.lapband.com for information. I hope that you are able to find the information that you are looking for. I am sorry that you are going through this. It's a lot to take in so do not give up.