Mert

That is a crazy rule! and a nonsense rule to boot!

Marlluvia, Is TX True Choice part of BCBS of TX? Are you in a big group? If you are in a group, I bet pre-existing conditions will be covered, so fills would be. I'm speculating.

I just got approval from BCBS of TX TRS Activecare. I had given up on them when I got the call that I was approved. What I did was go down their list and fax them everything they wanted on the list. The 12 months of documented medically supervised weight loss was what I could not handle either. So, I took all my medical records and wrote a letter pointing out all my illnessed that are obesity related. Hyperlipidemia, PCOS, back pain, chest pain, fatigue, even on an ultrasound of my ovaries in 2000 the tech noted that the patient was obese, making observation of the ovary difficult. I pointed out that obesity would impede preventive screens of all kinds. Pointed out that the cost of this surgery would be less than impending illnesses caused by obesity.Include in the letter all the diets I have tried in the past two years. My current documented weight at a doctor's visit prove that they failed. Sent all lab results, like complete blood chemistry and any borderline high readings. Find someone specific to fax it to, not one of the phone answerers at BCBS and call and make sure fax is received. They need lots of documentation. They want lots of paper. I think you can get it, you need to dedicate a lot of time to it and pray hard. I don't doubt that divine intervention got me my approval at last, but you gotta inundate them with paper, at least in my opinion...hope that helps you. It worked for me.

I'd like to hear your story too as I am in the process of making up my mind. who did your RNY and why is it better?

I checked and they said it is OK to change to a doctor who is in network, Speigel is not for BCBS, for me just to hand deliver the letter of approval to my new surgeon. All systems are go....... :clap2:

I have an appt. with my surgeon for the first time on the 18. I will take the approval letter w/ me and see what he says. I'm sure he'll want to run some tests on me.

Did Dr. Speigel send something in or was it something I sent into insurance?? Anyway just at the point of giving up and going to Mexico, literally, and BCBS TRS ACTIVECARE called and said I was approved. approved!! Must I eat my words?? This is nothing short of a miracle.

There is always the Monterrey option. I've heard only good things about Dr. Roberto Rumbault.

I'd stay away from Speigel's office. My consult was drive-by at best, the wife was discouraging about my insurance (why? too much trouble?), office staff unprofessional. Example: I'm trying to get back the material I sent them before I decided to run. they told me I needed to send $25 to get my medical records. They claimed they never rec'd the money order. His office operates on a cash only basis...what is up with that? Day before yesterday I rec'd an envelope from their office that was supposed to contain the psych eval my psychologist had faxed them. Instead I rec'd an empty envelope from them, addressed to me, that had never been sealed. ay Chihuahua........Needless to say I have since found another sugeon, but I wasted time with those ******* ... and what about their hokey adverisements?? yuck. Don't waste your time. We have a lot of good surgeons to choose from here in the Houston area. You CAN have a caring doctor who takes his time, efficient, kind and professional office staff, great aftercare, and experienced doctor. You can have it all. :clap2: :clap2: :clap2:

WOW I am impressed with the reviews. I would not hesitate to use him if I was self pay. Which I may be, if insurance does not come through. I'm glad I learned about him here.

thank you for that post of complication comparisons. it was an eye-opener for me

I haven't had surgery yet, but I can tell you some things I know I'm avoiding. I am two classes away from getting a certification I want but these last two classes aren't online, they are in person! yikes. What if I get to the classroom and they have those chairs with the attached desktops? So I quit working on the certification. I avoid people I haven't seen in a long time because I have gained one hundred plus lbs. since they saw me last. I avoid retreats at my church because I don't want to share a room with anyone and probably nobody wants to either. I avoid amusement/theme parks. I can't hold up, stamina wise, and the bar won't go over my belly on the rides. I avoid photos and people don't want to take my picture either. I avoid my big brother because he is a skinny person and very critical of me, so is his wife. I'll stop there. I'm just starting the process of surgeon/insurance at BMI 49.

thank you, I appreciate it. I originally went to Speigel because I talked to someone who had gone to him and she was happy with him. I was impressed with his experience also. Turns out, I am being lead a different direction now. Hopefully I won't have the same difficulty with office staff at Methodist.

I went to an informational seminar and got an appt to see Dr. Garth Davis on July 18. Although I am virtually starting over, I am much more comfortable with Methodist Hospital and their doctors. The Lord works in wonderful and mysterious ways.

Em, let us know what they say. You are lifted up in prayer.

barbara465, Point well taken. I am my own best advocate. I have been doing my own legwork for some time now. I just hadn't double checked with the insurance on what Speigel's office staff said they had already sent in. Some major problems in that office and my reaction is to run ..... Now looking for a new surgeon....

I love it.

Ok Everybody, it occurs to me that I am being too whiney and I need to just do it.:straight

Thanks Ericsmom, So that looks like a normal list of hoops to jump for the insurance company? I will keep you in my prayers on the 5th and congratulations on your surgery date. Please let me know how it goes. mm

Dolphin Dreams, did you even have to prove weight loss attempts, medically supervised? I am on plan 3, the supposedly best one, or at least most expensive. Here is what they asked for from me: 1)History and physical info incl. height, weight, and co-morbidities 2)Initial Evaluation 3)Documented history of morbid obesity (5 years) 4)evidence of at least 12 consecutive months of medically supervised, non-surgical methods of weight reduction with documentation that such efforts failed. the supervion must be provided by an MD, DO, or Nurse Practitioner. The weight reduction methods must include nutrition therapy, behavior modifying exercise or increase in activity, medication therapy and maintenance therapy. 5)psych evaluation 6) Documentation of willingness to comply with pre-op and post-op treatment plans 7)Documentation of procedures to be performed, with pertinent CPT codes. #4 is the tough one. the doctor in the network, Dr. Davis does provide a medically supervised weight program that costs for 6 months....$3800. I called and asked BCBS if they would pay for this (spoke to Meriah on 6/27/06) and she said "NO". hooboy:faint: Then I spoke to Janis, supervisor who Meriah transferred me to. I told her I had been to one doctor or another almost every month for the past year. I asked her did it have to be every month. Janis said no. Janis can look at their records of pay outs and see when I went to the doctors. Did they ask you for all this too? It is true I have been to doctors alot b/c I'm sick and worried about this metabolic problem and continual weight gain...:sick I'm sick and tired of being fat, sick and tired. OK this tirade is over:clap2: If you are still with me thank you for reading all this mess.

Tired Old Man, I heard a NASA official say "We are paid by the taxpayers to be risk takers" I dont think so! I can't even stand to watch the shuttle stuff on TV. It is too anxiety provoking. We need to keep them in our prayers, 'tis true.

I am glad to be here! I just found this website and think it is grand. I am currently seeking approval for surgery from the insurance in the title. Has anyone had experience with them? :help: the surgeon sent in about half of what is asked for in the policy book, but now insurance is asking for additional documentation. the surgeon's office is not calling my insurance. I am. And now I'm doing the legwork asking for more documentation from endocrinologist and internal specialist. Is this normal procedure?? Maybe the surgeon's office has some slackers working there?? Does it help to inundate with documentation? Should I send in articles from medical journals as well? I finally found a nice lady to talk to at BCBS!! She told me what more I needed and sounded encouraging... I hope she was sincere:nervous I am so nervous ... I attended my first seminar on May 30th, so I really just got started, no?:guess