SuzKelly

Thank you so much for your kinds words :) I Just got back from my second visit to the psychologist - and we had good long talk. I am going to go see someone about the RNY. I am feeling much better now.

My "journey" has come to a hault! I had my consultation today - only to be informed that BCN does not cover the sleeve in people with a BMI less than 50!!!! Mine is 43. What a bite in the arse~ Sigh. Guess it's not meant to be.

We are in so much debt right now - there's NO way I can dig our hole any deeper. Believe me, I toyed with that idea, but I just couldn't do that.

OMG - 2 years!!! Sheesh. Well I have an appt with my PCP on October 2 so I plan on talking with him about getting SERIOUS and aggressive with testing and what not. I guess that's where to start.. AND I have a second appt with the psychologist this coming Tuesday. Definitely going to keep that appt. AND I will keep playing the mega millions - maybe I'll win some money so I can self pay. LOL.

Well I am hoping to do a sleep study. I snore really bad - according to my family. And my knees are hurting me so bad - it's VERY hard to go down my basement steps. Some days are better than others. Even so - Blue Care network absolutely requires documented 6 months of weight loss program. Pbbbbt. I don't know what to do. That's so great that your surgeon was willing to go all out for you. I wish I could find one like that. My PCP doesn't seem to want to go to any extremes to help me. I already asked him and he said there was nothing he could do, because BCN has to have the records. Whatever. I am so digusted and depressed.

The policy is not on their website. Their website is useless, in my opinion. They did mail me the info. The sleeve is mentioned so I assumed it was covered.

Ohhh, believe me, I will NOT get the Band. NO Way! Self pay - no way I can do that. I cannot put our family into deeper debt than we already are. I played with the idea for a fleeting few seconds yesterday, but, no I cannot do that. My surgeon did suggest that I have the HR person at dh's employer contat BCN on my behalf to try to fight them to get them to make sleeve a covered benefit. Ohh, and another thing. I heard that the Sleeve might be getting a procedure code in january. So maybe I really need to get my ducks in a row - start getting my documented weight loss attempt going...and by january I could half way done .......If not - maybe I'll have to look at RNY as an alternative.....NO BAND. NO WAY! And lastly - for Vegas - I would have to gain 50 lbs to reach BMI of 50. There's no way in heck I am going to try to do that. I feel absolutely miserable now - I cannot imagine having 50 more lbs on this frame.

I am rather astonished at all the horror stories I have been reading lately about it......... I wonder how long before it does go bye bye. It's got to happen and the sleeve is going to be THE Surgery! don't you think? Pretty good article about the sleeve here: Laparoscopic Gastric Sleeve Overview - Is it the future of Weight Loss Surgery? | Medical Tourism

SO glad I discovered the Sleeve. I was all "band gung ho"....and my first impression of the sleeve was ICK! but then I started to dig more and read more and then the seminar I attended just sealed the deal for me. I hope one day in the near future I'll be here posting my Sleeve story!!!

I went for my evaluation today. Dr. was very nice. I felt at ease with him. Asked me if I had any serious health issues, which I do not (thank god) but I do have lower back problems from time to time (on prednisone right now for back trouble)...and I have bad knees from having flat feet and they do hurt me a lot. When we were done he asked if I had any questions. I did ask if he thought there would be a problem with me not having a 5 yr history of obesity problems with my doctor (I've been seeing him for more than 5 years but no paper trail of my obesity). He says..get this:.."I don't think you'll have any problems with your BMI of 40 and your knee and back problems!!!!!! I was like REALLY?? now he's been doing this for 22 years so I guess he knows what he's talking about, but that's a far cry from what I have been made to understand......and he know the surgeons WELL that I have my consult with, so.... Anyone have an experience similar to this???

Yeah I called them and they sent me a bunch of paperwork regarding all the requirements and coverage for bariatric surgeries. I have Blue Care Network - so their info a different from traditional Blue Cross. How I wish that requirement was dropped. LOL. The paper work I recieved was current as of July 1009 :cursing:

Yeah, that is good advice. I'll have to see if I can go by my doctor's office tomorrow and talk to someone about it. Thanks

Yup - you both are right. In all actuality - I feel rather silly complaining about the 6 month thing, since blue care network does NOT Owe me a weight loss surgery. So if I have to hoop jump - I hoop jump. I just feel lost right now as to what I could be doing to help move things along. Once I visit with the surgeon hopefully I'll have a better idea of what to do, what to expect to happen, etc....with the process. Like at the seminar we got a packet of info. In it is a sample letter to take to PCP for him to write for a patient to the insurance company. So I wonder - do I try to get my doctor to get that done right now? Do I wait til after my surgeon consult????? Questions questions questions.

Wow, Steph that sucks. I am sorry your insurance wouldn't cover it for you. I guess maybe I need to clarify my excitement here. I think I got ahead of myself here. I have been excited all day thinking that the dr today was implying that I would get approved no questions asked, no documentation of 6 months weight loss program. So I went back over my paperwork that BCN sent me and it says : The surgical procedures for severe obesity are considred established treatment options if all the following criteria are met: The patient has a BMI>40 or a BMI of >35 with co-morbid conditions The patient has been clinically evaluated by an MD. The physician has documented failure of non-surgical management indlucing a structured, professionally supervised weight loss program for a minimum of 6 consecutive months within the last 4 years prior to the recommendation for bariatric surgery. The 6 months program listed above is wavied for super morbidly obese individuals who ahve BMI =50. DOcumentation should include periodic weights, dietary therapy and physical exercise, as well as behavioral therapy, counseling, and pharmacotherapy as indicated. Ok, now I am reading that to mean that even though I habe BMI 41 with the joint problems =- I still would need that 6 months documentation right?? Ugh. That just makes me sick really. I lost count of all my times joining WW (the same center no less, they know me like old family there)........and I did have a few times of 6 months consecutively and lost a good amount of weight..but no within last 4 years. Sigh. This is frustrating. :thumbup:

Hi There. I started out on the lapband talk forum. I had my mind all set that is the way I wanted to go. But then I started to get pulled in this different direction. I went to a seminar last night put on by the surgeon's office I have my consult scheduled with. My mind is made up. I want the sleeve. There was a lady that spoke at the seminar last night that had the sleeve done last November. She feels and looks great. My consult is 9/26/09. I am going for my pysch evaluation tomorrow afternoon!! I have Blue Care Network. I have no idea what hoops I'll have to jump through to do this, but I am ready, willing, and Able!!!! Suzy in Michigan. (detroit area)

Hi again and thanks all for responding to me! It feels good to "not be alone". My mind is just racing right now. I am so excited about this I can't see straight. And I know I shouldn't be letting myself get so carried away, but I can't help it. A year ago I would've never given WLS a thought for myself. " I mean - I CAN lose weight on my own. I don't need that" was in my mind But something just clicked in me - yes I know HOW to LOSE= but I am not able to keep it off or keep up the lifestyle change it took to get it off. So by gosh IF there is a tool out there to help people like me and everyone else around here, then if I can be lucky enough to take part, then here I am! I hope I settle down after I see the surgeon. I need to start eating right and gearing up for the change. I admit, I am disappointed about maybe having to do the 6 month program so that Blue Care Network can have their documentation of my trying .....oy oy oy. And since I have no real health issues, my doctor doesn't have much of a paper trail on me regarding weight.

So, I had started to embrace it. And decided that I would go to my doctor for the 6 months (monthly visits). Well I just called Blue Care Network to see if that was a covered procedure code. He tells me that I it was to be a weekly weigh in for 6 months. ARGH. I really don't want to join Weight Watchers for the 267th time in my life. Not to mention I really cannot afford it right now. So now head is swimming again. he tells me that seeing the doctor once a month isn't going to give them what they need to approve me. blah blah blah!

ha - don't I wish I could self pay! But unforutantely I am in so much debt now - there's No Way! UPDATE - I just called Blue Care Network AGAIN to clarify that weekly weigh ins were the criteria for the 6months. It's not cut and dried according to the woman I spoke with. I have been thinking all this time that it's my PCP who will send all the info in to insurance. It's not - according to her - she says that the Surgeon is the one that decides what I will need to do and HE will be the one to submit info to the insurance. THAT really clears thingsup for me. So I will just simmer down and wait and see what he says to me on the 26th. Maybe I am getting my panties in a wad over nothing, then again maybe I will be doing some major hoop - jumping!

Thanks, Brandy. Yup I will definitely be asking him about that. He's actually doing the seminar that I am attending Monday the 14th. Maybe I can find out then! You know the real kicker...I would sort of like to go through a weight loss program with the same hospital, but the medical instead of surgical. But my insurance won't cover THAT. I just need something drastic at this point. sigh.

That is awesome:thumbup::thumbup: Good for you!! :frown:

BlueTopaz....what you said has made me feel so much better about the 6 month time thing. Puts it in a whole new perspective for me. I am going to ask my PCP if he will at least count my first visit to him talk about this as a first visit towards my 6 months. LOL. he could at least do that for me ya know? Anyway = Liz what do you think? Make you feel any better about things not happening "yesterday"... :w00t:

This is the first I have heard of the 5 year thing. Well, I've been a YO YO for as long as I can remember. LOL. Brandy, yes I guess it is a hoop.. I just feel so ROTTEN and need this Jumpstart so badly. ugh.

Hey Liz I am right there with ya wanting to know what goes on in the consult! AND wondering if there's anything the surgeon could do so speed things up with those of us that have the 6 month time constraint. Probably not. I asked my PCP last night if he could do anything and he said no. sigh. I am so doggone healthy everywhere else, just TOO FAT to do anything. Oh well. Your Monday will be here soon!!!!!!!! I can't wait to hear what goes on.

Congrats on going for your consult!!! Have you been to a seminar? I am going next Monday to seminar. Excited about that...then my pysch evaluation on Wenesday. I have a surgeon consult on Sept 26. Please come back and let us know how the consult goes!!!!

Hi Angie. I am new around here as well! Good luck to you. I wish I could go self pay - I would in a heartbeat. But I'll have to go through 6 months of weight loss program before being approved. MY insurance approves when you have a BMI of 50 or more. Such a shame your insurance excludes everything for weight loss. Hang in there..:w00t: