Just Got Approved For Lap Band Surgery!!! Bcbs

[SecretBeauty 2]

On 11/16 my papers were submitted for review with BCBS Today on 12/2 I was approved!!! Took 2.5 weeks. I tried soooo hard not to think about it while I was waiting. I have weight to lose b4 surgery and that's my last hurdle. I'm so exited I'm out of breath but I figured bcbs people might like to know the approximate wait time. cheers!

[horsegirl315 114]

Congrats!! BCBS of RI took a month to approve me. Do you have a surgery date yet??

[Hopeful to be full 11]

congrats on your approval! I have BCBS of pa and had to wait about the same amount of time for approval. I hope u get your surgery date soon! Good Luck! Today is day two post-op for me....doing good. You will be too!

[Grider 92]

I was approved yest submitted last Tues BCBS fed plan weeee, finally! Surgery Dec 22.. I am elated!

[3nuthut 32]

I too was just approved by BCBSTX. We sumitted on Dec 1st, I called yesterday to check the status and they had mailed the approval letter that day! 8 days? Wow, I'm impressed.

[kr8160311 36]

Congrats everyone!! I have empire bcbs and will be submitting my paperwork on Feb 10th as my last appt with the Dr. is on feb 9th. can I ask what was required of you . It seems empire bcbs does ask for records of last reported weight etc. Thanks and congrats everyone!!

[Cocoabean 430]

Congrats everyone!! I have empire bcbs and will be submitting my paperwork on Feb 10th as my last appt with the Dr. is on feb 9th. can I ask what was required of you . It seems empire bcbs does ask for records of last reported weight etc. Thanks and congrats everyone!!

You can call them or look online to find out what their requirements are. Each BCBS seems to be a bit different. Plus they change each year, so you never can tell for sure.

[kr8160311 36]

Thanks so much. Here is mine It looks like I dont have to send in years of records of weight loss am I reading this correct? I hope so since I dont have any. It looks pretty easy but I'm how can that be?? lol

Medically Necessary:

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band^® System or the REALIZE^™ Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:

1. BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:
   
   • diabetes mellitus; or
     
   • cardiovascular disease; or
     
   • hypertension; or
     
   • life threatening cardio-pulmonary problems, (e.g., severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND
     

[*]The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND

[*]The physician requesting authorization for the surgery must confirm the following:

• The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
  
• The candidate's post-operative expectations have been addressed; and
  
• The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
  
• The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
  
• The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
  
• The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
  
• The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.
  

Medically Necessary:

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band^® System or the REALIZE^™ Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:

1. BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:
   
   • diabetes mellitus; or
     
   • cardiovascular disease; or
     
   • hypertension; or
     
   • life threatening cardio-pulmonary problems, (e.g., severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND
     

[*]The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND

[*]The physician requesting authorization for the surgery must confirm the following:

• The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
  
• The candidate's post-operative expectations have been addressed; and
  
• The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
  
• The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
  
• The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
  
• The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
  
• The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.
  

[Cocoabean 430]

It appears you'll have to convince the surgeon that you've dieted in the past. I don't see any mention of length of time you must have been obese, either. You'll need a pre-op psych exam, that is pretty standard. The exam itself varies by doctor.

And depending on your BMI you might need a co-morbidity.

It seems pretty straight forward, actually. :-)