Bcbs - Ks & Sc

[TracyinKS 7]

OKKKKKKKKK

Pysc Eval scheduled for NEXT Wednesday 1/17/06, I had to make several calls to places on my insurance network... one place totally ticked me off.. they were all high and mighty said I needed a minimum of 3 sessions, tried to tell ME what my insurance would want. I told them they were mistaken and that I would call my next provider on my list.........

So the doc I did find, it is a one session 2 part meeting.. 1st in an interview and second is a pencil test. Said he should have results and letter to me by the 25th.......... cost of this is $200.00 but they are bcbs.

Just waiting for the nutritionist to get back to me!

P.S. I did call my company EAP plan. Unfortunately, they can't get involved with any letter writing.. so using them is out. (which is why I'm glad I went ahead and started calling places IN network)

The places that were accepting new patients were either booking into the middle of February, or very demanding... (I'll be using my Flex Spending Account for the eval)

[TracyinKS 7]

Meeting with the nutritionist is set for 1/22....

Looks like thats all I can do now is play the waiting game.

[TracyinKS 7]

In a little over an hour, I leave my office for my psychologist appointment.. I admit I'm a litte nervous as I've never done anything like this before.

[Candle 11]

Good luck!!

[TracyinKS 7]

I'm back, I survived! 3 hours including an assement that included 567 true/false questions................. YUCK! $200 out of pocket, because my FSA card was declined. So I'm gettting ready to fax my reimbursement form in.

[2bthinagn 3]

I went to Dr Malleys seminar this week. I was impressed with his layed back attitude. He was funny and a cutey. I did set up my consult appt. I have to wait for Ctr of Excellence approval for a hospital since I am a Medicare person. I have learned so much from this website. I felt like I could get up there and answer questions! I am also going to Sedalia for Dr Hornbostel's seminar in Feb. If I choose Sedalia for all this, there probably will be very little out of pocket for me.But it may be a year before I can have the surgery due to his wait list of patients. If I go with Dr Malley, it will be maybe Feb for a surgery date and will cost me $5300. So after I go to Sedalia I will have a decision to make.

[airwayman 2]

I HATE to burst any bubbles but, Tracy, did you specifically tell BCBS you were having LAP-BAND surgery? Yes, the cover weight loss surgery, RNY, duodenal switch (or whatever it's called) but NOT the LAP-BAND. This from the horse's mouth (or some part of the horse) from BCBS North Carolina as of yesterday. Most of the worker-bees you talk to know weight loss surgery is covered if you hit the BMI mark, have documented weight loss failures, etc. etc. But, what they don't know is the types of weight loss surgery that's covered. If you specifically ask them (which I did yesterday and have done in the past years) "do you see where AGB procedures are covered" the answer always comes back...."oh, is that gastric banding....no, it's not covered." I hope I'm wrong, really I do. I am going to have to self pay next month if you can't help get these idiots to realize the benefits (and future cost savings) of the AGB.

[TracyinKS 7]

Airwayman... your not bursting my bubble..... I have been all over them since before I even had my consult because I am the HR person for my company.. and I was just dog and pony'd over the summer at BCBS SC headquarters because our entire system changed to BCBS... it was THERE at the roundtable discussion with all the other HR people from all over that I even found out OUR COMPANY had the PROVISION for WLS.. and it was always there... just unknown..... my company is self insured and that means our SPD is public knowledge.........

Long story a little bit shorter... our Contract with bcbs IS inclusive of WLS, but it does have to be medically necessary, which has to be proven by doctors documentation.. if you've read my entire thread you will see emails from REAL bcbs people.... and their admission that we are covered.

The insurance guru at the docs office spent 45 minutes on the phone with them (on hold) when finally.... they said YES it is covered under the following criteria:

1. BMI over 40 or 35 and 2 comorbitities

2. Letter from a psychologist stating that I am of stable mind to make my own health decisions.

3. Letter from a Nutritionist Eval. (I used the one referred to me by the docs office)

*NOTE: NO 6 month supervised diet ***

After I get the letters to the doc, she then submits everything to the BCBS for the claim number to be assigned.. at that time I will schedule my date.

I am hopefull to have a date set next week... I'm looking at March right now and possibly April... due to the in-network hospital availability.

OH and YES, I have CPT code 43770 committed to memory, I have included it in EVERY email and phone conversation.. AND I've added it to my FSA reimbursement for the psych and nutritionist eval....

[airwayman 2]

Long story a little bit shorter... our Contract with bcbs IS inclusive of WLS, but it does have to be medically necessary, which has to be proven by doctors documentation.. if you've read my entire thread you will see emails from REAL bcbs people.... and their admission that we are covered.

The insurance guru at the docs office spent 45 minutes on the phone with them (on hold) when finally.... they said YES it is covered under the following criteria:

1. BMI over 40 or 35 and 2 comorbitities

2. Letter from a psychologist stating that I am of stable mind to make my own health decisions.

3. Letter from a Nutritionist Eval. (I used the one referred to me by the docs office)

*NOTE: NO 6 month supervised diet ***

After I get the letters to the doc, she then submits everything to the BCBS for the claim number to be assigned.. at that time I will schedule my date.

It's not the coverage for WLS that worries me...I have the BCBS of NC Corporate Medical Policy titled Surgery for Morbid Obesity last updated August 2006. And, my company insurance covers WLS (doesn's say what type, just that if it's deemed medically necessary, it's covered). The problem is buried back in the BCBS policy under the heading When Surgery for Morbid Obesity is Not Covered, item No. 2 subpart d. says 'gastric banding.' Has anyone out there who is covered by BCBS actually had gastric banding surgery, submitted a claim and had it paid? Please let us hear from you.

[TracyinKS 7]

I'll keep you posted, but yes there are many on these boards that have some version of BCBS (even employees of BCBS) and had it covered..... I can't remeber her screen name but one employee stated that all they have to do now is fill out a survey. GOOD LUCK ON YOUR JOURNEY!

[TracyinKS 7]

Airwayman.. here is the policy that my bcbs goes by.... Sorry for its length. and here is the linkhttp://67.32.116.245/Internet/cmpd/cmp/mdclplcy.nsf/DispContent/F326B0F4EB49705E8525717700528079?opendocument

CAM 70147

Surgery for Morbid Obesity

Category:Surgery Last Reviewed:November 2006Department(s):Medical Affairs Next Review:November 2007Original Date:July 1996

Description:

Morbid obesity is defined as an increase in weight over optimal weight that results in significant complications and a shortened life span. For example, morbid obesity has a significant impact on cardiac risk factors, incidence of diabetes, obstructive sleep apnea and various types of cancers (for men: colon, rectum and prostate; for women: breast, uterus and ovaries). The first treatment of morbid obesity is obviously dietary and lifestyle changes. Although this strategy may be effective in some patients, frequently the weight loss is not durable, with only five to ten percent of patients maintaining the weight loss for more than a few years.

When conservative measures fail, some patients may consider surgical approaches. A 1991 National Institutes of Health (NIH) Consensus Conference defined surgical candidates as those patients with a body mass index (BMI)* of greater than 40 kg/m-2, or greater than 35 kg/m-2 in conjunction with severe comorbidities such as cardiopulmonary complications or severe diabetes. Super obesity has been described as a BMI greater than 50 kg/m-2.

Surgery for morbid obesity, termed bariatric surgery, falls into two general categories:

1. Gastric restrictive procedures that create a small gastric pouch, resulting in weight loss by producing early satiety and thus decreasing dietary intake.
   
2. Malabsorptive procedures, which produce weight loss due to malabsorption without necessarily requiring dietary modification.
   

The following summarizes the different restrictive and malabsorptive procedures.

Gastric Restrictive Procedures:

1. Vertical-Banded Gastroplasty
   Vertical-banded gastroplasty is probably the most common kind of gastric restrictive procedure performed in this country. The stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch a plug of stomach is removed and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are rare. Complications include esophageal reflux, dilation or obstruction of the stoma, with the latter two requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach.
   
2. Adjustable Gastric Banding – (gastric restrictive procedure without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty)
   Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore, the rate-limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, one such device is approved by the U.S. food and Drug Administration (FDA) for marketing in the United States, Lap-Band (BioEnterics, Carpentiera, Ca.). The labeled indications for this device are as follows:
   
   "The Lap-Band system is indicated for use in weight reduction for severely obese patients with a body mass index (BMI) of at least 40 and a maximum BMI of less than 50 with one or more severe co-morbid conditions, or those who are 100 lbs. or more over their estimated ideal weight. It is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives."
   
   
3. OpenGastric Bypass – (gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [less than 100 cm] Roux-en-Y gastroenterostomy)
   The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves a horizontal or vertical partition of the stomach in association with a Roux-en-Y procedure (i.e., a gastrojejunal anastomosis). Thus, the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant "dumping syndrome," in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain and/or vomiting. The dumping syndrome may further reduce intake, particularly in "sweets eaters." Operative complications include leakage and marginal ulceration at the anastomotic site.
   
   Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures, including Iron deficiency anemia, Vitamin B-12 deficiency and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the "blind" bypassed portion of the stomach. Gastric bypass may be performed with either an open or laparoscopic technique.
   
   
4. Laparoscopic Gastric Bypass (laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy [roux limb 150 cm or less])
   Essentially described the same procedure as above (see No. 3 above), but performed laparoscopically.
   
   
5. Mini-Gastric Bypass
   Recently, a variant of the gastric bypass, called the mini-gastric bypass, has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach but rather the type of anastomosis used.
   
   

Malabsorptive Procedures:

There are multiple variants of malabsorptive procedures, which differ in the lengths of the alimentary limb, the biliopancreatic limb and the common limb, where the alimentary and biliopancreatic limbs are anastomosed. The degree of malabsorption is related to the length of the alimentary and common limbs. For example, a shorter alimentary limb (i.e., the greater the amount of intestine that is excluded from the nutrient flow) will be associated with malabsorption of a variety of nutrients, while a short common limb (i.e., the biliopancreatic juices are allowed to mix with nutrients for only a short segment) will primarily limit absorption of fat.

1. Biliopancreatic Bypass Procedure (also known as the Scopinaro procedure) gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption
   Biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure. The procedure consists of the following components:
   

• A distal gastrectomy functions to induce a temporary early satiety and/or the dumping syndrome in the early postoperative period, both of which limit food intake.
  
• A 200-cm long "alimentary tract" consists of 200 cm of ileum connecting the stomach to a common distal segment.
  
• A 300- to 400-cm "biliary tract," which connects the duodenum, jejunum and remaining ileum to the common distal segment.
  
• A 50- to 100-cm "common tract," where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel, i.e., creating a selective malabsorption. The length of the common segment will influence the degree of malabsorption.
  
• Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy.

Many potential metabolic complications are related to biliopancreatic bypass, including most prominently Iron deficiency anemia, Protein malnutrition, hypocalcemia and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition. In addition, there have been several case reports of liver failure resulting in death or liver transplant.

1. Biliopancreatic Bypass with Duodenal Switch (Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileosteomy [50 to 100 cm common channel] to limit absorption [biliopancreatic diversion with duodenal switch])
   Specifically identifies the duodenal switch procedure introduced in 2005. The duodenal switch procedure is essentially a variant of the biliopancreatic bypass described here. However, instead of performing a distal gastrectomy, a "sleeve" gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary limb. Preservation of the pyloric sphincter is designed to be more physiologic.
   
   The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass (i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment).
   
2. Long Limb Gastric Bypass (i.e., > 150 cm) (Gastric restrictive procedure with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption)
   Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures, which vary in the length of the alimentary and common limbs. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. While the long alimentary limb permits absorption of most nutrients, the short common limb primarily limits absorption of fats. The stomach may be bypassed in a variety of ways (i.e., either by resection or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the anastomoses. Note that CPT code for gastric bypass explicitly describes a short limb (<150 cm) Roux-en-Y gastroenterostomy, and thus would not apply to long limb gastric bypass.
   
3. Laparoscopic Malabsorptive procedure (Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption)
   Introduced in 2005 to specifically describe a laparoscopic malabsorptive procedure.
   
4. Vertical Sleeve Gastrectomy is a procedure that induces weight loss by restricting food intake. Approximately 60 percent of the stomach is removed and takes the shape of a tube or "sleeve".
   

Policy:

1. Gastric Restrictive Procedures
   Open gastric bypass using a Roux-en-Y anastomosis or vertical-banded gastroplasty with an alimentary or "Roux" limb of 150 cm or less may be considered MEDICALLY NECESSARY in the following:

• Treatment of morbid obesity that has not responded to conservative measures.
  
• BMI (Body Mass Index) exceeding 40.
  
• BMI greater than 35 in conjunction with severe co-morbidities (CAD, Type 2 Diabetes, medically refractory hypertension, etc.).
  

Laparoscopic gastric bypass using a Roux-en-Y anastomosis, or vertical-banded gastroplasty, is considered MEDICALLY NECESSARY in the following:

• Treatment of morbid obesity that has not responded to conservative measures.
  
• At increased risk of adverse consequences of a RYGB due to the presence of any of the following:
  
  • Hepatic cirrhosis with elevated liver function tests.
    
  • Inflammatory bowel disease (Crohn’s disease or ulcertative colitis).
    
  • Radiation enteritis.
    
  • Demonstrated abdominal surgery, multiple minor surgeries, or major trauma.
    
  • Poorly controlled system disease.
    

Laparoscopic Adjustable Gastric Banding (Lap-Band) is considered MEDICALLY NECESSARY in the following:

• Treatment of morbid obesity that has not responded to conservative measures.
  
• At increased risk of adverse consequences of a RYGB due to the presence of any of the following:
  
  • Hepatic cirrhosis with elevated liver function tests.
    
  • Inflammatory bowel disease (Crohn’s disease or ulcertative colitis).
    
  • Radiation enteritis.
    
  • Demonstrated abdominal surgery, multiple minor surgeries or major trauma.
    
  • Poorly controlled system disease.
    
  • Above minimum BMI requirement and, in addition, have a maximum BMI of less than 50.
    

Gastric banding, consisting of an external band placed around the stomach, is considered INVESTIGATIONAL as a treatment of morbid obesity.

Gastric bypass using a Billroth II type of anastomosis, popularized as the mini-gastric bypass, is considered INVESTIGATIONAL as a treatment of morbid obesity.

1. Malabsorptive Procedures
   Biliopancreatic bypass (i.e., the Scopinaro procedure), biliopancreatic bypass with duodenal switch, or long limb gastric bypass procedures (i.e., >150 cm) is considered INVESTIGATIONAL as a treatment of morbid obesity.
   
2. Vertical Sleeve Gastrectomy is considered INVESTIGATIONAL.
   

Policy Guidelines:

Patient Selection Criteria:

Morbid obesity is defined as a body mass index (BMI) greater than 40kg/m-2 or a BMI greater than 35 kg/m-2 with associated complications including, but not limited to diabetes, hypertension or obstructive sleep apnea.

*BMI is calculated by dividing a patient’s weight (in kilograms) by height (in meters) squared.

• To convert pounds to kilograms, multiply pounds by 0.45
  
• To convert inches to meters, multiply inches by .0254
  

It should be noted that all bariatric surgeries require a high degree of patient compliance. For gastric restrictive procedures the weight loss is primarily due to reduced caloric intake, and thus the patient must be committed to eating small meals, reinforced by early satiety. For example, gastric restrictive surgery will not be successful in patients who consume high volumes of calorie rich liquids. In patients undergoing biliopancreatic bypass, reduced intake may not be as much of an issue, but patients must adhere to a balanced diet to avoid metabolic complications. In addition, the high potential for metabolic complications requires life-long follow-up. Therefore patient selection is a critical process, requiring psychiatric evaluation and a multidisciplinary team approach. Given these factors, bariatric surgery should be approached very cautiously in adolescents.

References:

1. National Institutes of Health. Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med 1991;115(12):956-61.
   
2. MacLean LD, Rhode BM, Forse RA. Late results of vertical banded gastroplasty for morbid and super obesity. Surgery 1990; 107(1):20-7.
   
3. Brolin RE. Results of obesity surgery. Gastroenterol Clin North Am 1987; 16(2):317-38.
   
4. Kolanowski J. Gastroplasty for morbid obesity: the internist’s view. Int J Obes Metab Disord 1995; 19(suppl 3):S61-5.
   
5. Melissas J, Christodoulakis M, Spyridakis M et al. Disorders associated with clinically severe obesity: significant improvement after surgical weight reduction. South Med J 1998; 91(12):1143-8.
   
6. Hall JC, Watts JM, O’Brien PE et al. Gastric surgery for morbid obesity. The Adelaide Study. Ann Surg 1990; 211(4):419-27.
   
7. Griffen WO. Gastric bypass. In: Surgical Management of Morbid Obesity. Griffen WO, Printen KJ (eds.). New York: Marcel Dekker, Inc; 1987. Pages 27-45.
   
8. Pories WJ, Swanson MS, MacDonald KG et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222(3):339-52.
   
9. Flickinger EG, Sinar DR, Swanson M. Gastric bypass. Gastroenterol Clin North Am 1987;16(2):283-92.
   
10. Cowan GS, Buffington CK. Significant changes in blood pressure, glucose and lipids with gastric bypass surgery. World J Surg 1998; 22(9):987-92.
    
11. Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 2001; 11(3):276-80.
    
12. Doherty C, Maher JW, Heitshusen DS. Prospective investigation of complications, reoperations and sustained weight loss with an adjustable gastric banding device for treatment of morbid obesity. J Gastrointest Surg 1998; 2(1):102-8.
    
13. Doherty C, Maher JW, Heitshusen DS. An interval report on prospective investigation of adjustable silicone gastric banding devices for the treatment of severe obesity. Eur J Gastroenterol Hepatol 1999; 11(2):115-9.
    
14. Miller K, Hell E. Laparoscopic adjustable gastric banding: a prospective four-year follow-up study. Obes Surg 1999; 9(2):183-7.
    
15. Suter M, Giusti V, Heraief E et al. Early results of laparoscopic gastric banding compared with open vertical banded gastroplasty. Obes Surg 1999; 9(4):374-80.
    
16. Hell E, Miller KA, Moorehead MK et al. Evaluation of health status and quality of life after bariatric surgery: comparison of standard Roux-en-Y gastric bypass, vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding. Obes Surg 2000; 10(3):214-9.
    
17. Scopinaro N, Gianetta E, Adami GF et al. Biliopancreatic diversion for obesity at eighteen years. Surgery 1996; 119(3):261-8.
    
18. Totte E, Hendrickx L, van Hee R. Biliopancreatic diversion for treatment of morbid obesity: experience in 180 consecutive cases. Obes Surg 1999; 9(2):161-5.
    
19. Nanni G, Balduzzi GF, Capoluongo R et al. Biliopancreatic diversion: clinical experience. Obes Surg 1997; 7(1):26-9.
    
20. Murr MM, Balsiger BM, Kennedy FP et al. Malabsorptive procedures for severe obesity: comparison of pancreaticobiliary bypass and very very long limb Roux-en-Y gastric bypass. J Gastrointest Surg 1999; 3(6):607-12.
    
21. Sugerman HJ, Kellum JM, DeMaria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg 1997; 1(6):517-25.
    
22. Marceau P, Hould FS, Simard S et al. Biliopancreatic diversion with duodenal switch. World J Surg 1998; 22(9):947-54.
    
23. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg 1998; 8(3):267-82.
    
24. Baltasar A, del Rio J, Escriva C et al. Preliminary results of the duodenal switch. Obes Surg 1997; 7(6):500-4.
    
25. Brolin RE, LaMarca LB, Kenler HA et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002; 6(2):195-205.
    
26. Mason EE, Tang S, Renquist KE et al. A decade of change in obesity surgery. National Bariatric Surgery Registry (NBSR) Contributors. Obes Surg 1997; 7(3):189-97.
    
27. Mason EE, Doherty C, Maher JW et al. Super obesity and gastric reduction procedures. Gastroenterol Clin North Am 1987; 16(3):495-502.
    
28. Brolin RE. Results of obesity surgery. Gastroenterol Clin North Am 1987; 16(2):317-38.
    
29. Ontario Ministry of Health and Long-Term Care, Medical Advisory Secretariat. Bariatric surgery. Health Technology Literature Review. Toronto, ON: Ontario Ministry of Health and Long-Term Care; January 2005.
    
30. Tice JA. Laparoscopic gastric banding for the treatment of morbid obesity. Technology Assessment. San Francisco, CA: California Technology Assessment Forum; June 9, 2004.
    
31. Tice JA. Duodenal switch procedure for the treatment of morbid obesity. Technology Assessment. San Francisco, CA: California Technology Assessment Forum; February 11, 2004.
    
32. Obesity Surgery Specialists Website for the LAP-BAND® System:
    
33. LAP-BAND: Laparoscopic Obesity Surgery: A Renaissance in Surgical Procedures for Clinically Severe Obesity.
    
    

[TracyinKS 7]

Keeping everyone up to date.

Had a call from the psychologist and an email from the Nutritionist.. both will have my letters of approval to the surgeons office by tomorrow! YIPPEE....... once done, the insurance guru can submit all info to BCBS for the claim number.... Should have a date soooooooon.

[Red wine lover 0]

Keeping everyone up to date.

Had a call from the psychologist and an email from the Nutritionist.. both will have my letters of approval to the surgeons office by tomorrow! YIPPEE....... once done, the insurance guru can submit all info to BCBS for the claim number.... Should have a date soooooooon.

Yeah Tracy! :clap2:

I know how you feel. Hang in there!

Bill

[TracyinKS 7]

Thanks Bill! I'm TRYING!

[airwayman 2]

Airwayman.. here is the policy that my bcbs goes by.... Sorry for its length. and here is the linkhttp://67.32.116.245/Internet/cmpd/cmp/mdclplcy.nsf/DispContent/F326B0F4EB49705E8525717700528079?opendocument

Gastric banding, consisting of an external band placed around the stomach, is considered INVESTIGATIONAL as a treatment of morbid obesity.

The key phrase in the document is noted above. My BCBS won't pay for procedures that are classed as investigational. Once again, I am NOT trying to be a pessimist, just want pass along the info that I've received. I have a call into BCBS in my home state of NC and will vigorously fight them on this 'investigational' wording. Thanks for all the good information you have given me. JB