blue cross blue shield

[ShyTexRose 0]

I need to get out my calendars to be sure about the timeline. I think I have been working on it almost 2 years. I was really disappointed last spring when I thought I had done all my documentation. I went to Weight Watchers for 7 months thinking it would help me document and learn stuff too but it didn't help. What really helped was going through AIGB for weight checks. They did the application for me this time. Also, they called me when they heard the documentation of monthly weight checks needed to be 6 months instead of a year. It helped having them on my side.

Now it is up to me. The hard part. Doing without my favorite drug - food.

[Sandybells 0]

I don't remember seeing you on here before but then I have been rather scarce! I wish you a speedy recovery when you do get the surgery. I think I read you will have it on Dec. 21? I haven't looked at your statistics but will soon. Best of luck on your journey!

[ShyTexRose 0]

My surgery date is December 21. I am doing the pre-op diet.

My start before the pre-op diet was 245.

Thanks for the hi.

[Chris1982 2]

I have bcbs of New Jersey Horizon ppo and I just got my aproval today it took a while but I finaly got it.

[Chris_NJ 9]

FED EMP> BSBC said that after Jan.1 2007, I could have the procedure covered due to changes in the 2007

I came across the 2007 call letter for FEHB on line and it is now REQUIRED that FEHBP plans cover WLS! Its' about time! I also agree to fight fight fight! The squeeky wheel gets the grease, huh? However, if you look @ the different plans, their requirements can be/are different, so be careful!

:clap2:

Yup just called the other day myself and was told the 1st. they even told me the page in the new book. I think the page was 40 something.

[ShyTexRose 0]

Yes, AIGB told me that BCBS made it easier at the end of November ( I think). So, I had mine December 21.

[bosteph 2]

Every BCBS is different. As I posted earlier, mine covered it without needing any medically supervised weight loss programs.

[jenjen 0]

I have BCBS of MN. I just got their policy yesterday in the mail and it said I needed 1 year of a documented weight loss program. So would WW qualify? Does anyone know? If not, what would qualify. I'm near Memphis so if anyone has a suggestion that's near there, that would help too. I've seen several who had to have 6 months and was surprised my company requires 1 year.

Thanks,

Jen

[ShyTexRose 0]

Hi, jenjen

This is what I just went through. I did WW and it did not count. I contacted the American Institute of Gastric Banding and they monitored me. When they reapplied I was approved. BCBS here required a year until recently. The AIGB knew what to do to get approved as well as taught me a lot. I had applied twice and been refused.

Good luck.

Banded 12-21-06

[synicalchick 0]

Hi kindredspirit -

I was initially declined for the procedure, but received approval from BCBS just yesterday. Keep up the good fight!

Nathalie

Hi there,

How long did it take you to go from being denied to being approved? What all did you provide for the appeal?

Thanks,

Tracy

329 lbs BMI 54 age 36

[johnr441 0]

I am very confused. Iwas just denired lap Band surgery by BCBS because my BMI was over 50 . They would approve Gastric bypass but I would need to get my BMI down to 40 to have the Band approved does this sound right to you guys? :help:

[piercedqt78 658]

I am very confused. Iwas just denired lap Band surgery by BCBS because my BMI was over 50 . They would approve Gastric bypass but I would need to get my BMI down to 40 to have the Band approved does this sound right to you guys? :help:

That sounds odd to me, have your doctor provide a letter explaining why the band is a better option for you. Make sure that the letter explaines that the proceedure is safer, with a smoother recovery time. There are a multitude of reasons that the band is better for you, have the doctor make your case is a letter. ~Mandy

[Lap_dancer 8]

I am very confused. Iwas just denired lap Band surgery by BCBS because my BMI was over 50 . They would approve Gastric bypass but I would need to get my BMI down to 40 to have the Band approved does this sound right to you guys? :help:

John the only thing I can tell you is that my surgeon would like me near 315, I'm at 360 right now. It could be a thing with the surgeon or with the particular center you are going with. Sounds right to me. My surgeon won't touch anyone at 375. The table won't hold anyone that heavy.

[piercedqt78 658]

The table won't hold anyone that heavy.

If the table won't hold anyone that heavy how are they going to do GBP? There are several super morbidly obese people here that have the band. Some started with BMI's of well over 50. ~Mandy

[Lap_dancer 8]

Congrats to all of you who are with the band. I envy you and hope to be there soon.

Right now I am so flustered with BCBS of Florida.

I went to my seminar in Sept. Had LOADS of tests done which include:

X-ray and ultrasound of stomach, medically induced stress test for my heart, colonoscopy and the other one down the throat plus test for the bacteria in the stomach, full blood work, sleep study for apnea (positive).

BCBS of Florida denied because it is a specific exclusion from my policy.

My doctor is 100% behind me. he has drafted letters and together I am appealing.

Level One appeal was a joke. I asked to be in on the conference call where four individuals asked me nothing other than did I want to add anything regarding my file. I did request an immediately answer via phone call if they would be so kind. I'm a big girl and promised not to yell at them. I got the call, denied. Level Two appeals happening January 9th.

I took pictures of myself NUDE. That's right. I flipped the fat, flashed the flesh and JPEG'd it to the nurse in charge of my case. 10 big old shots of me baring it all. I put some nipple in there just to be shameless. ( you have to have humor or you cry )

Meanwhile to answer questions for folks who are researching. There are states, North Carolina specifically, that uses "Centers of Excellence" for bariatrics, I think 12 doctors. They did so because many doctors not necessarily trained were doing GBP and other WLSurgery. The latest study shows a great reduction in post-operative hospital stays as a result. Of course BCBS is bragging about this.

Google "BCBS Center Excellence" and follow those hits.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

I add a personal letter to each level of Appeal. Here is my latest:

Dear Review Panel:

Presented to you for review is my case for a gastric procedure known as a laproscopic banding procedure or "Lap-Band". In a lower review, BCBSFL did not dispute that I meet the criteria for the Lap-Band procedure. There is no dispute that I would benefit from weight loss surgery and there is no dispute that losing weight would be beneficial to my health. At issue is the coverage of this surgery and the exception I am requesting for this exclusion. Ironically, I received a phone call a few weeks ago from BCBSFL's new Diagnostics Program that offers support to wellness. Through this program, I gained beneficial information in the form of a booklet, catalog and DVD on the very weight loss surgery I am requesting.

There is evidence in my medical records that I have tried for years multiple weight loss regimens and used pharmacotherapy for obesity under the supervision of my physician, Dr. ILOVEYOUSOMUCH. For my mental state, it is documented by my therapist, IMA CRACKEDPOT, that I have a full understanding of what this procedure entails and that it will be a lifetime commitment on my part. There is no indication that I am unstable, misinformed with perceptions of unrealistic expectations; Rather so, that I have pursued this avenue under the direction of my primary care physician and other medical personnel, with cooperation, information and education; That I am laying the course for my surgical event and post surgical life by the compass of these individuals and their combined medical expertise demonstrates I am an individual who very much wishes to be healed.

Unquestionably, I am ill and feel I am fighting for my life. As a result of my severe morbid obesity, I suffer from sleep apnea, diabetes, depression, back problems, joint pain, hypertension, Migraines, Pictures will show my condition and the severity of my obesity. It is true that my life is endangered. This procedure will prevent the worsening of my condition, alleviate present harmful medical conditions and perhaps cure them. It is the conclusion of my physican(s) and myself that I am in need of this operation. Please authorize my surgery.

Additional:

As providers of health care coverage, Blue Cross and Blue Shield has historically authorized weight loss surgery. Currently, Blue Cross and Blue Shield of North Carolina cut in half hospital re-admissions "by the twelve surgeons in North Carolina that are designated as centers of excellence for bariatric (obesity) surgery." Additionally, BCBSNC was one of the first insurers in the nation to officially recognize centers of excellence for bariatric surgery. Illinois also follows this model as well as South Dakota, Iowa, Michigan and several other states.

In recent publications in the Tampa Bay area, BCBSFL appears to be using bariatric surgery denials as a financial decision rather than one in the best interest of patient care. I must express my concern that with sufficient evidence from their medical providers and informed decisions with which they move forward, it is very troubling that patient/physician decisions of health necessity are disrupted, ignored and denied, superceded by a focus on cost. It is hoped that Florida will soon follow the successful excellence practice as established by Blue Cross and Blue Shield in other states.