daco525

I am trying to get everything ready to submit in May to the ins co. I am now hearing something about "exercise" or going to a trainer. What is all of this about. I do have records of a gym membership in the last 2 years but I have not gone to a trainer. Are people actually going to a trainer and having a report sent on their behalf?

Great info thanks.

I am gathering everything. I have all my weight watcher books with weights from previous years. I made copies to submit along with everything else. Does it hurt to show the ins. co that when I joined(& rejoined several times) weight watchers my BMI was between 35-38 at all initial weigh ins. Then as I followed program and lost weight I did go down to a BMI of 32-35. Of course I always gained all the weight and then some back. I have weight watcher weigh in books for 2005, 2007,2008. I have just started my 6 month doctor supervised weigh ins. The first weigh in was December and the BMI was 39. I anticipate that the BMI will be 35 at last weigh in. I have heard that if you don't show a weight loss you will be denied because you are unable to prove that you can follow a weight loss program and comply with recommendations. Any help or experience with this would be appreciated.

I have all my six month appts for my monitored weight loss set up. The first appt was Dec. the last is May. I am now hearing that they will only count this as 5 months. The first appt actually counts as your initial weigh in with your doctor and not as a month of weight loss. Has anyone had this problem. I have BCBS NJ. I just want to have everything right before it is submitted. I want to be approved the first time around.

I thought about this, I think I would go with the gastric bypass. I am afraid to continue with the medical conditions associated with obesity, I fear a heart attack in the next 6 years.

Now I am concerned that they may not see my 6 months weigh in as a full 6 months. Here are the dates of my dr. appts. 12/26, 1/22, 2/16, 3/9, 4/12, 5/1. I planned on having the dr send his notes from each visit indicating weigh in, diet and exercise. I hope they don't say the first appt 12/26 was an initial weigh in and then we need 6 months after of actual diet. Anyone have any experience with this. I don't want to get hung up another month, I am really trying to get the surgery done in the summer since I don't work then, more time for recovery.

Be sure you document the time, day and person you spoke with. The last time I called and reviewed exactly what was needed for approval and they even gave me a reference # after the call. Keep at it, I think it will all turn out in your favor.

I think you should definitely appeal. I am surprised that they are giving you a hard time with your BMI above 40. My understanding is you are exempt from the 6 month weigh in and I thought you just needed to have a doctors note and have all the pre-surgery test completed. Did you try call the ins. to find out why they are denying it? My BMI is 38 so I have to jump through the hoops to prove medical necessity. I have several co-morbidities (diabetes, hypertension, high cholesterol) but I still have alot of hoops to jump through.

If your BMI is 40 or above then I believe you can just go for your tests, have your weight verified by your doctor and you are set. The problem is if your between 35-40 then they ask for the 6 consecutive month doctor supervised diet. I actually had 9 months of weight watcher where I went consecutively every week and this is still not good enough. I just started my 6 months appt. last month. I will be finished in May. Also they want the actual doctor notes from each visit and the notes must contain info about diet and exercise.

Prepare to jump through alot of hoops. Here is what I am told BCBSNJ needs for approval. Documented weights from the past two years (these need to be from your doctor). A six month consecutive weight loss program monitored by your doctor. If you miss even one month you have to start all over. You need a BMI 40 or great or 35-40 but then you must have co-morbidities. All of this must be documented by your doctor. You can send other info to support your claim but without this I think they will deny. I started the process of looking into a surgeon in Nov. I am now jumping through all the hoops and I am hoping to submit everything and get an approval in May. Best of luck. Let us know how everything turns out.

Do you have any complications or pains with joints. I too have a BMI of 35-38 (I fluctuate), I have high bp, diabetes, and high cholesterol. I recently developed some problems with me feet and ankles which I believe is related to weight. I am going to see about having the podiatrist send a letter on me behalf for lap band also. The more people (doctors) on your side the better. I started my 6 month doctor visits last month. I am counting on approval because of the comorbidities. I did speak with the ins. and they seemed positive. Have you tried calling them first. By the way, when I submit my paperwork I will not submit any of my weight under 35, I too have several because of various diets. My ins. only requires 2 years history.

Like many, I still have several appts to complete for my 6 month doctor visits. In the meantime I decided that I am going to keep a positive outlook. Since 2009 seems to be the year that everyone is talking about "change" in our country. I decided that I would give myself a lap band "hope chest". Something like a bride gets while planning and waiting for her wedding date. My hope chest is a wooden box that I am filling with things that will be used when I am banded. This weekend I made a few small purchases for my "lap band hope chest". I brought a really nice diet journal. I brought some new tupperwares that hold small portions (2 oz). I purchased a cookbook with recipes for people who have had bariartric surgery. Finally I purchased a really pretty pair of stockings. They are holiday stockings that were 75% marked down. They have glitter snowflakes on them. I hope that maybe next christmas I can wear a pretty dress and my new stockings. Just a fun way to try and make the waiting seem upbeat. I really am hoping for an approval. My last 6 month appt will not be until May.

I have just begun the process of my 6 month weight loss visits. I was informed by the surgeons office that the insurance company will not want to see a weight gain and if they do they will probably deny me. I questioned this and they told me because it just proves to them that I cannot follow the recommendations from my doctor and therefore I may not be successful with the lap band. Honestly I made sure I gained 10 lbs. before my first weigh in. My first weigh in was the day after christmas. I felt like this assured me that I should be able to show a loss. I just wonder how much of a loss is ok. I also heard you have to be careful not to lose too much. I think it all depends on your ins. I have BCBS NJ.

Thanks for the info, it was very helpful. I am looking at all options. I currently have a BMI of 38 but I do have co-morbidities (diabetes, hypertension, high cholesterol). I spoke with the insurance company and they seemed very hopeful. I actually thought you would have paid more, $7000. seems quite reasonable and I am glad you had such a good experience. I could justify a one time visit vacation/surgery but the fills would be hard, since I am located in NJ. I will find out about ins. approval in May. I will be finished with my 6 month doctor supervised weight loss visits then. Right now I want to be educated with all options. Thanks again.

These questions may seem silly but after you return to the states will your insurance cover the fills. Is it easy to find a doctor that will take you since their office did not do the initial banding. Do they speak english where you were banded? Right now I am trying to seek insurance approval but if denied I know this is a possible option. If you don't mind sharing what was the entire expense for the trip and procedure.

I have diabetes (type II), hypertension, high cholesterol, all under control with meds. I recently have been going to a podiatrist for bone spurs that I think are from too much weight. My BMI is at its highest at 39. Over the 6 month supervised weight loss should I try to not loss more that about 10 lbs. Some people are telling me not be too successful, they even say only loss 5 lbs. I thought 5 lbs. shows very little effort. If I loss 10 I still have a BMI between 35-40 with comorbidities.

I just went for my first of six appts this week. I believe it is just a supervised weight loss program with your doctor. He needs to document in his notes what you are doing as far as diet and exercise. I sure can't see going back to weight watchers. I have done this so many times. All I want to do is complete my six months and submit everything and hopefully receive approval.

I am really working hard to gather info. I currently have Horizon BCBS of NJ. I have a BMI of 36 with the following co-morbidities: diabetes typeII, hypertension, high cholesterol. My BMI has fluctuated from 34-36 in the past two years. So far I have a note from my primary. He also list the last 9 months weigh ins. I went for the psychological eval last week. I have an appt for the nutritionalist eval next week. I wonder if I should send all my daily food logs from Weight Watchers along with my 6 month weigh in notes. I am so afraid of being denied. My paperwork will show that I was successful on WW, I lost close to 30 lbs. but unfortunately I gained it all back in 3 months. The sad story of my life. I need to get off this roller coaster and I am hoping the lap band will help me. If anyone has any suggestions of what else I should send to help my case, please share.

I currently have a BMI of 36 with co-morbid conditions: diabetes, hypertension, high cholesterol. I can document my past weight, but several times my BMI has been under 35. I am always dieting. Do you think this will be cause for a denial. I am assuming that the co-morbid conditions qualifies me for having this done medically.

How do I go about contacting them. Is there an "800" # or do I just google it. I am located in NJ. Thanks for sharing your story. I have an appt with the nutritionist on Mon. I am still getting things together to submit to my ins. I hope this all goes well. I would like to be prepared in case I do get denied because I would want to appeal it.

Good for you. I will persist also if I am denied. I made my mind up that I am committed to getting this done. Good luck, keep us posted.

Although you BMI wasn't consistently over 35, did you have any co-morbidities. I do have diabetes, hypertension and high cholesterol. I really hope my health will be he deciding factor.

My ins. Horizon BCBS of NJ is requiring 6 consecutive months of doctor visits where diet is being monitored medically. Here is the question. I have 9 months of weight watchers. I sent my 9 months of weight watcher weigh in documents to my doctor. He wrote up a letter document the consecutive weigh ins. We also wrote up monthly notes about diet, exercise, behavioral changes which they also want. Do you think the insurance will accept this or will I be denied since I did not actually go to my doctors for 6 appts. Will they be able to tell this? I do go every 3 months for treatment of co-morbid conditions. If this is grounds for denial I am thinking I should start this month making an appt. By the time I submit everything to insurance in Jan., if they deny it by Feb. I will at least have 3 months of the visits completed. Any info or experience with this would be helpful.

This is more work than I expected. I contacted my primary doctor who I see every three months. They are preparing a letter that list my 6 month consecutive weight loss. I sent him a copy of my weight watcher records that have 9 consecutive months of weight loss from Oct 2007-April 2008. He is constructing his letter with this info. I hope this is what ins wants. I have an appt tomorrow for the psych eval and in 2 weeks the nutritionalist eval. I was also going to send proof of a gym membership and my attendance for 3 months from 2006. I also have records that I attended nutrition counseling about 5 years ago. I am also gathering some of my mom's medical records showing a family history of weight related health issues. I thought the more I send the better. My BMI is 36 but I have diabetes, high cholesterol and hypertension. I have Horizon BCBS for my carrier. What do you think? I really need this to be approved.