BCBS = 1 ; Patient (me) = 0

[2beskinny 4]

Hello! I have BCBS of Ill and they covered 100% of my surgery (banded April 30th 2010). The only thing I had to do was see my general doctor once a month for 3 months for a "doctor prescribed" diet......I have been with my doctor since 1998 and I am a nurse so we, um, "documented" at each visit that I was on a high Protein low fat diet and checked my weight and BP at each visit....cost me $15 a month. Then I saw a dietician and had a psych eval (luckily from the SAME person who happend to be both) during one visit....she also is a bandster! That is all I had to do. The surgeon wrote a "Letter of Necessity" and turned it in with all of the information sent over from the doctors and we heard back within 2 weeks that I was covered!

Give it a try! You will be so happy when they tell you that it is covered at 100%.....hopefully! BTW my BMI was a 36-40 fluctuating and I had NO other co-morbities (diabetes, hypertension, etc.....)!

Good Luck!

Warmly,

Leslie

Awesome for you!!!! Nice when you have the inside track and it saves you time, huh? Same thing about the girl I know waiting for her surgery...she knew exactly what was necessary and her primary care doctor worked with her to submit everything necessary. She was approved after the 1st submission. I've heard stories from her as well as doc's office of people doing their physician supervised diet (for 6 months or longer sometimes!) and when they "turn it in" it doesn't necessarily have ALL the documentation they were looking for and were told they had to start over! What a bummer that would be!

[Karlzmom 1]

i was not BC/BS, but my appproval flew through in part because I provided all of the journals from WW that I still had [i'm kind of a paper pack rat ], copies of my credit card statements for jenny craig meals and my gym memberships. Heck, I even photocopied my key ring with my gym and Curves member tag-card on it! LOL. Of course, not everyone she deals with had been "really" working on the issue for as long as that, as some decide surgery and then "build the record"...but in any event the paper proofs worked. The coordinator said she'd never sent a packed that big to my carrier before.

Perhaps you already have "evidence"...do you have gym memberships that you have canceled checks or credit card statements? WW? Jenny Craig? other weightloss purchases?

Good Luck. Try not to look at it as just a "tactic", everyone wants us to suceed..our doctors, our programs and even our carriers..albeit for different reasons. Ensuring that we are truly committed to the process and willing to expend effort, not just espouse good intentions is the way our carriers become satisfied we are doing what is best. After all, we are going to have make the same efforts after, so we may as well get a head start. [also known as "I choose to view things in a positive light"] No, I don't work for an insurance company...

I am sorry that you got your hopes up and now have to wait. It must be difficult to deal with in an already emotionally draining process. Hang in there, it sounds like your doctor will help guide you and in no time at all you will join the ranks of Bandster!

[2beskinny 4]

I did the 3 month BCBS required supervision. My doctor didn't demand that I lose weight but he did want me to make lifestyle changes each month that would make me more successful post op. I was miffed at first but really appreciated both the psych eval, where I was encouraged to really think about this choice and talk it out with the counselor, and the nutritionist, who helped me understand the relationship between the band and my future dietary choices. Between them all I felt much more in control, and have come to appreciate BCBS' requirements.

I totally get what you mean about appreciating the requirements...I'm starting to turn the corner on that as well. I think the initial frustration comes from years of battling this issue, years of dieting, gaining, and then having to prove "you've made an effort." It can initially seem condesending, even though it's not. I'm beginning to feel it's all about having the right attitude and not waiting for a surgery date to get your head into the whole process! It's about appreciating each step as important to the final goal

[karmaandkismet 0]

I've wondered what the docs thought about doing phentermine while you do your three month supervised diet. I have BCBS of Ill. and even though I did WW last summer, I didn't check in with my doctor each month so I am anticipating having to do the three month supervised diet. The only other times I have been "successful" with weight loss is when I was on the phentermine because I wasn't hungry! I'm hoping that the band will truly help curb my appetite. I can keep myself busy and occupied but its hard to concentrate when you are constantly hungry. Yesterday I had a pb and banana sandwich and I was still hungry.

[s.smith 0]

I would pull your medical policy and read the requirements for approval. BC/BS requirements vary in each state. With my friends she had to have a BMI over 40 for a period of three years and be on a six month doctor supervised diet with no proof of weight loss. Mine required a BMI over 40 for a period of 5 years or a 35 BMI with one of 6 co-morbid conditions and a six month supervised weight loss proving that I could loose at least 5% of my initial body weight. They can all be tricky! Just a heads up...

[2beskinny 4]

I've wondered what the docs thought about doing phentermine while you do your three month supervised diet. I have BCBS of Ill. and even though I did WW last summer, I didn't check in with my doctor each month so I am anticipating having to do the three month supervised diet. The only other times I have been "successful" with weight loss is when I was on the phentermine because I wasn't hungry! I'm hoping that the band will truly help curb my appetite. I can keep myself busy and occupied but its hard to concentrate when you are constantly hungry. Yesterday I had a pb and banana sandwich and I was still hungry.

I just talked to my surgeon about that exact thing. I really wanted to do phentermine until surgery - just to get going on this journey! I saw another wls doc last year who prescribes it and lost 25 pounds pretty easily on it. 10 years ago I did phen-fen and lost ALL my weight on that. His answer was that he was not a big fan of the drug. He said he prescribes it for his patients that have to lose a significant amount of weight just to make the surgery even possible for them. I am at a 40 bmi and he flat out told me, "you don't need phentermine - you need the band." He was right. I have adjusted my attidude to do it on my own and not take the drug anymore (even though he told me I could go back to my other doc if I wanted to and get a prescription). I asked him if I did decide to take it, would it make surgery any more risky, meaning should I stop taking it 2 weeks before surgery, etc. He said I could take it the day before surgery and that would be ok, but his point was why take it and give yourself a heart attack when you are only 6 weeks away from surgery which is what you need anyway. He just didn't feel it was worth the health risk when I'm on track for getting banded. Makes sense to me now. It's my Quest for immediate gratification that wants to take it!!! I'm impatient :confused:

[Becca29 0]

2beskinny- Sorry I might have misspoken. My surgeons office told me that once my 3 month sup diet is met that i will be approved. Apparently we have very good insurance..she told me Fepblue Basic is one of the best out there. Im excited to get things going and 3 months will fly by..I have nothing better to do in the mean time i guess. Keep me updated and let me know how things are going with you. Id love to join you in your journey..sounds like we have a lot of the same issues going on.