BCBS - What are they thinking?

[Angels 0]

GOD is GOOD ALL the TIME!! Happy for you! I trusted in GOD but to be honest I was too impatient and very nervous about being approved and to be GOD be the glory I was approved and have been banded since April 4, 2006. GOOD LUCK and welcome aboard!!!!!

[Mert 0]

Dolphin Dreams,

I am starting a new job this year. Now I am approved and am wondering, since I don't have time to get this done and recuperate this summer... how long will I need to take off, in your opinion, from the classroom? I realize this is a guess. I am 49, strong, and have a BMI of 49. I know the surgery is more important than the job, since the job can be replaced. So while I have the approval I want to get it done ASAP. Some doctor's offices give me the impression that I can practically jump off the table and get right back in the swing of things. Thanks for listening.

[dolphin_dreams 0]

Mert, contratulations on your approval. I remember how excited I was too. I'm now 8 months out and this band has truly been a wonderful tool! I'm praying you will have a wonderful experience as well.

Regarding the time off from work, I had surgery on a Tuesday and went back to work the following Monday. I have to admit that I was a little tired at the end of the day for the first few days back.(First graders are rarely still.) Since my surgery was in November, I was only back at work for 1 week before we had Thanksgiving break. I had another week off for the Holiday which really helped. I think that even without that week though that I would have been okay.

Good luck with your new classroom and let me know if you have any other questions!

[Mert 0]

Wow Only a week! That is great news. Thanks for the info. Yes I am very excited that I was approved by insurance and can get it done right here in Houston. I was on my way to Monterrey otherwise. I just could not wait a year. I go to see my surgeon on Tues....I hope we can get this done quickly. It would still be nice to get it done before school starts!!

[casb37 0]

Mert, Congraulations on your apporval, I hope everything goes well for you. I'll keep you in my prayers. Also I'll be back on the battlefield with BC/BS HealthSelect of TX. if there are no changes in my plan after the fiscal year in Sept. Please keep me in your Prayers. Again congraulations !

[Mert 0]

Best of luck to you Casb37. I lifted you up in prayer, that you get the procedure you need to help restore your body to health. Please let me know how it is going with you.

[TX_Quilter 0]

I happened to have copies of about the last 10 years of medical history from when I had requested medical records from one doctor to new doctor when we moved to Houston.

As far as I'm concerned, all those notations where he was scolding me for gaining weight, that he renewed prescriptions (for weight loss) and his comments about my successes (and mostly failures) would count as documentation for supervised medical diets.

It also shows the additions of co-morbidities along with failures over the years. It was kind of depressing reading it all at one time.

Anyway, I've decided to switch doctors. Can't get that insurance approved if they won't even submit it!

[Mert 0]

It may be depressing, but you are way ahead by having all those doctor's notes. Thats great, from an insurance approval pt. of view....

[mosermel 0]

I have BCBS of Florida and medcost. Im hoping one will get approved. Im scared to get excited because i dont my hopes shattered. I want this surgery so bad. I would love to feel like a normal person again. I feel like im looking at someone else in the mirror everyday and wondering what in the world happened to me. anyway, im curious to know how everyone was with BCBs and how much everyone has lost with the lap band

[wantlapband 0]

anyone have any example letters that their psych doctors wrote?

Mine was terrible, nothing in it that I needed to have said. I have been seeing this guy for 2 years, then I stopped for a year, and just went again in July and told him about the surgery..so I told him what type of letter I needed to have...like I have family support, etc....

All he wrote was, I haven't seen her in a year and she says she is stable.

I mean I can't send that in, my insurance company will never approve it. I'm so pissed at him. I would like to call his office and explain to him that that letter will not help me, he knew me for 2 straight years.

I should have gone with the psych doc from the surgeons office, but I said oh I have my own..yeah great..now if I want to get another appt, I will probably have to wait a long time, and then my insurance approval will be put on hold because they need this letter...and my surgery will be postponed.

[s1m1 0]

I had to appeal the BC/BS decision not to pay for my lapband surgery and eventually won. I had 2 co-morbidities and a sky-high BMI but did not have the 6 month medically supervised diet. It was definitely an exercise in persistence but I won.

How difficult was your appeal? I have Unitied Healthcare. I just submitted, and anticipate being rejected. I meet all the requirements except the six month physician supervised diet. I've tried everything from weight watchers too Atkins. I lost, but I gained it right back. If they don't approve it, I'm going to just pay out of pocket and try to fight for reimbursement later. Do you think that will be possible?

Darrell... 8/1/06 338lbs

[libra 13]

I have BC/BS and was approved in one week. Like others have said here, I think it depends on your individual plans.

As for the psych letter, (my psychiatrist is the one who referred me to my doctor, he just had his done, BTW) Here is the text of mine.

To whom it may concern,

The patient was seen for evaluation prior to scheduling her gastric banding surgery. Upon mental status examination, the patient's mood was euthymic (had to look that one up, lol) with logical thought processes. She has suffered from obesity since early childhood. She reports trying multiple diets and weight loss supplements each time with no positive results. She understand she is at risk for developing medical co-morbidities due to obesity.

She was able to discuss the procedure and was able to state the risks versus the benefits of having gastric banding surgery. She understands that she will need to make major adjustments to her lifestyle and eating habits both prior to and after the procedure. At this time, there are no contraindications in terms of mental status for she to consent to gastric banding surgery. There is no history of addiction or substance abuse and she had adequate family support.

Any questions contact blah, blah, blah.

I also had letters from a nutritionist I saw saying that we disucussed my necessary dietary changes and how I will counter my emotional eating habits. And a letter from my regular doctor briefly describing how he monitored some weight loss programs with me. For example, I was on Meridia as well as Xenical and Phentermine. So BC/BS was bombarded with recommendations. My surgeons office knew exactly what each insurance company would need for approval and gave me a list of what I would need. I followed that.

Good luck to those appealing...

[wantlapband 0]

That is a good letter.

I have to go to another psych doc...what an idiot...I'm so mad..I feel like calling him back and telling him.

I'm on Xenical also....hasn't worked yet.

I have BC/BS in New Hampshire...I hope that I get approved...my surgery date is set for sept. 20th.

[dotofoz 0]

Wantlapband: You're lucky they only wanted a letter (from your Dr.) and not a 545 T/F question MMPI-2 and interview! That's what was required of my BC/BS (FEP, BLUE HMO OH)After that, then they required a "report" from the administering Dr. Mine sounded similar to Libra's, however she stated that I was OK, but needed my meds managed B4 & after surgery. Well, my new shrink (in our 2 meetings) said how wonderful I'd do w/the surgery. Well I get letter that she (actual shrink) said I shouldn't have surgery and she doesn't see bariatric patients! Come on lady make up your mind! IF you don't see bariatric patients, how can you draw an educated conclusion that someone shouldn't have the surgery? Now, I finally got referred to a Dr. that DOES see bariatric pt's and of course can't get into see him 'til 9/11 (great date, I know). I think this all is a lesson in perserverance if nothing else! And my goal was to be banded by end of October, '06? In my dreams!:eek:

[brendalaps06 0]

Hi, I'm Brenda and I have Premera BC/BS in AK. I was denied by Blue Cross 5 or so years ago to have this surgery done. I gave up. I researched and spoke with a great group up here about surgeries in other countries. But, never followed up. I see people who are 1/4 or 1/2 their original size when I met them 5 years ago!!

Now fast forward to August 2006, I'm ready to have this surgery done with the blessing from my Orthopedic Surgeon whose the best in our state. I'm pending a fusion and scared to death to have it done. I'm 40 years old, and have a lifetime of back problems if they don't want to pay for it, instead they may have to pay for my back -- that is how I see it.

Say positive prayers for me on my new weightloss journey.