BCBS Federal Requirements for Lap Band

[ladybug108 7]

Ok not happy now lol! Psych eval and weight loss program not at doctors. I will call them later.

[pinx 18]

Finally! I got my psych eval back. The thing was that my doctor's office called and was told another date again. So, I patiently waited while another date came and went. I called and they said they never said any of that, in regards to the time I'd get it back. They basically said my husband, myself, and my doctor's office all misheard the dates. Whatever! So, when I called and was told that, I called my doctor's office back. They called them AGAIN and was pushed off again with a new date NEXT week! I was like OH HECK NO! Anyway, long story short, after explaining what I was told and having them check my records, they saw the documented conversations with the psych people and called again to find out what was going on... this time armed with the conversations and got the fax within minutes! That just proves my theory that these people where just holding on to it! I have no clue why it was so hard to SIGN a paper, but oh well... it is done! :D

They submitted my stuff to BCBS as of Friday afternoon, so I will let you all know how long it took from the last piece of paperwork to approval if that helps you all out!

[ladybug108 7]

Yay! I want to push up my nutrition date! I can't wait another 3 week's. Only problem is that I would have to take a full day off from work cause they are 1.5 hours away. I am going to check on my other stuff Tuesday to make sure they have it. I'm ready to get this over with lol! I've never had patience. I can't wait to hear your approval date. Good luck!

[krg75 33]

Glad your BCBS will pay, some underwriters wont. I am a total self pay with BCBS-TX. They have a no bariatric policy. They will not cover ANYTHING bariatric related...even with other health conditions. My sister also have BCBS-TX (seperate employer) and hers covers...go figure. Good luck to you!! My surgery is March 18th!! YAY ME!!

[ladybug108 7]

Well I found out today I have to redo my weight loss program. My first appt is tomorrow. Should be done by mid May so hopefully I can get surgery in June. Pushed me two months back but I should be ok I hope.

[BigOBoy123 67]

Why do you have to redo your program? Does your insurance require your weight loss program to be immediately before the surgery or can it be anytime before the procedure?

[pinx 18]

That sucks, Ladybug! Do you know why? Tomorrow to Friday should be when I hear back about being approved. *Crosses Fingers* I'm getting excited, but nervous!

[ladybug108 7]

The doctor's office said it was my program was more than a year old. She told me she just had that issue with another patient that has my same insurance. I didn't think there was a big deal about it but hey she knows best right? She also said it would be a couple of weeks before she gets my psych letter but I'm not sure about that one. I won't rush it though cause it will be three months before surgery lol. I want to tell her to send it in anyways but not sure I should.

I started it today at 85 bucks a month not reimbursed by my FSA.

I guess that what I get for chickening out.

[pinx 18]

The program I had to go through was $115 a month, and also not covered. Isn't it funny how insurance works? They won't pay to help you lose weight without surgery, but will with it! Waiting sucks, but it is going to be worth it!

[ladybug108 7]

I'm getting excited. I'm scared. Don't want to lose too much weight.

[pinx 18]

I know how you feel. I've lost 14 lbs since going on sugar busters and am afraid I will lose too much. If I had to go on another 3 month diet, I know I'd be under the BMI requirement. We started at a similar weight, but your BMI is a little higher, so you must be a little shorter than I am, lol. Like the doctor said though, it isn't that I can't lose weight. It is that I cannot keep it off. What happens is I do really well, plateau, then gain it all back plus some! Now with the other health issues, it has gotten to the point that I have to do something long term for my health.

[m1aman 944]

My doc told me it doesn't matter how much weight you lose during this phase because the only weight they ever report to the insurance is the weight from the initial appointment. After that the insurance co doesn't know if you lose weight or not. Not saying yours is the same, just throwing that out there for you.

[ladybug108 7]

Yeah my BMI today was a little lower. Like you said I lose, plateau, and then gain back. I don't have any other health problems at the moment but I could at any moment. You r on sugar busters already? Yeah I'm 5'3".

[ladybug108 7]

My doc told me it doesn't matter how much weight you lose during this phase because the only weight they ever report to the insurance is the weight from the initial appointment. After that the insurance co doesn't know if you lose weight or not. Not saying yours is the same' date=' just throwing that out there for you.[/quote']

Very nice to know! I was way bigger when I started this journey! But still have the BMI.

[pinx 18]

Thanks Dober. That was a worry of mine and I was scared to ask!

They put me on sugar busters already because if the psych eval snag up didn't happen, I would have already been banded. I had a couple of tantrums having to wait because I wanted to have that "last meal" but like someone told me... that is the food addiction talking. I allowed myself to have one last treat a couple of days ago and ended up barely touching it (a cupcake) because it was too sweet! It was so not worth it! However, I had to figure that out on my own. After that, I have no desire for sweets. Plus, I've found healthy alternatives anyway. One example is that fruit tastes really sweet now!