Help! What's your interpretation..

[FlyGirl 18]

Here's a little background first. I've been thru the seminar and 1st appt with my surgeon. I have my Psych eval, Nutrition eval & PCP appt within the next two weeks. And I have BCBS of GA.

Ok, I need some help. It looks like I meet all of the criteria to have insurance cover my surgery but what does this mean?...

"The patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery"

To me that means my surgeon, not my PCP, but when I went to my 1st appt the lady who handles ins said that probably means I need to have a history of physician supervised weight loss attempt from my PCP.

Now I'm stressing because I don't have that... oh boy.

[Tiffykins 673]

Don't stress. Your surgeon needs to have you list out what you've done on your own to lose weight my list looked like this:

Paid Programs for Weight loss: Weight Watchers - 4 years 99, 2003, 2005, 2007, on all attempts I attended weekly meetings, and weigh ins. Stuck to the program lost anywhere between 30-60lbs, but would gain it back.

Nutrisystem in 2006- lost about 20 pounds but the cost of food, and having to prepare a complete meal for my son was far too expensive.

Weigh Down Workshop: Faith based weight loss program offered through my church. Lost 50-70lbs over 2 years.

Exercise and various physical changes: 1 hour 4 times a week of hip hop abs for 1 year - lost 40lbs, hurt my knee and had to quit working out, a year later joined 24hr fitness and worked out with weights, and isolated core. Lost 20-30lbs, but moved and gained the weight back

Behavioral modifications: Park furthest away from the store front when going shopping, ate off a smaller plate to help cut portions, ate slowly and extended my meals over 30 minutes, cut all fried foods out of my diet, cut out soda and alcohol

Diet Attempts: Weight Watchers, Nutrisystem, Atkins (several times), FenPhen, Adipex, herbal weight loss supplements such as Metabolife and Slimquick.

I lost weight with all of these attempts, the issue isn't losing, it's keeping my weight off.

I added that last little tidbit at the end. My insurance coordinator faxed my sheet in directly to the insurance company. My surgeon signed off on it. I had to do this for both my band and revision.

[FlyGirl 18]

Thank You Tiffykins!! That makes sense now, this is all new to me and I'm just trying to get it all straight so they have no reason to deny me.

I've read almost all of your posts and they've been so very helpful! And btw you look great!!

--Kelli :-)

[Tiffykins 673]

Thank You Tiffykins!! That makes sense now, this is all new to me and I'm just trying to get it all straight so they have no reason to deny me.

I've read almost all of your posts and they've been so very helpful! And btw you look great!!

--Kelli :-)

Thanks Kelli

I'm an insurance agent as well so I have a good, solid grasp of what they want. . .

[KabinKitty 11]

I hope Tiffykins is right in your case. I also have BC/BS, but I'm in Ohio. I just got my denial letter in the mail on Friday.

There are a few states where BC/BS is finally approving the sleeve, but most (as in Ohio) still consider it investigational/experimental. I will be appealing their decision.

I'm VERY surprized your surgeon's ins. gal didn't understand the language in your policy!! My surgeon required me to be under the supervision of his hospital's nutritionist for 3 months. They don't really expect you to lose weight, but it is encouraged.

I still got denied. I'm sure they would have approved an RNY in a heartbeat, as I meet all their requirements.

You should be able to go to your BC/BS website and read what is allowed and what is excluded. My surgeon's ins. gal basically lied when she told me at the seminar that she wasn't having any trouble getting approval's for the sleeve through BC/BS.

I expected to be denied and figured she was not being honest with me. I'm ready for a fight now!:thumbdown:

[Dansha 16]

Kelli, I have Federal BC/BS of Kansas City and what Tiff wrote was all that was required by me. When I went for my psych eval. the doc had previously sent me some paperwork and there were some questions that asked me about what kind of diets I had been on ,how long, and how much I had lost.

I'm five weeks post op, so that must have done the trick. Good luck!!!

Deb

[FlyGirl 18]

Thanks everyone for your input! I'll keep you all posted!

[FlyGirl 18]

Hey guys I was approved today!! Hoooraaaay! Surgery date 11/16/10

Thanks Tiffy for giving me an idea for the letter, I really think that helped!

Thank u everyone!~~