Alabama Here

[Tcisme 13]

Hey I'm in North Mississippi.... But having surgery in Memphis.

Not sure of my surgery date yet... Still have alottttt to do.

Did everybody have to get 3 months of Dr. Reports with your BMI before your pshc eval or nutritionist??

[Jacqueline K 93]

Hey I'm in North Mississippi.... But having surgery in Memphis.

Not sure of my surgery date yet... Still have alottttt to do.

Did everybody have to get 3 months of Dr. Reports with your BMI before your pshc eval or nutritionist??

I didn't need any medical records- my insurance didn't require them and my Bariatric Coordinator said if insurance didn't then she didn't. Everyone's experience is different depending on insurance and surgeon requirements.

[Tcisme 13]

Oh ok... Yea I think my insurance requires it. I'm sooooo ready to get this process started. I'm will go to the 2nd dr. Visit Wed. Then one more month and I can meet with the others... Getting Closer!!

[ArmyOfMe 82]

How close are u 2 surgery?

If Tricare approves me (I think miss Margaret submitted my case already, not sure though), I would have my surgery by end of May. I am moving in less than two months, reason why the surgeon wants me on the OR table asap. I need some time for recovery and post-op appointments to make sure I am healing properly, before I leave AL.

[Tcisme 13]

I'm not sure I'm hoping everything is ready by July.... That's when my insurance will kick in. I think I have plenty of time... I hope

[joyaskins34 31]

Yes I had to have 3 years worth of med records..and when Margaret submitted mine they denied me on Friday because they said that wasn't included in what she submitted ..her response was yes it was...they said my bmi was not high enough during 3 years..she said she has sleep apnea!!! They said mail in hard copies..they would re-review so now I wait! She said if they deny again DrP will talk to medical director and hopefully that wil get approval..but hoping the approve second appeal! ..so hoping praying they will approve this time! I'm stressing OUT!!!i Ha!! Never been told I'm not "fat"enough! :/

[Tcisme 13]

Well I have sleep apnea... They said that they didn't need my medication list that if I had sleep apnea it would automatically approve for surgery.

[joyaskins34 31]

Well I have sleep apnea... They said that they didn't need my medication list that if I had sleep apnea it would automatically approve for surgery.

That's basically what bcbs requirements say but still had to send them in..they just wanna make it hard for ppl in hopes of giving up

[ArmyOfMe 82]

Yes I had to have 3 years worth of med records..and when Margaret submitted mine they denied me on Friday because they said that wasn't included in what she submitted ..her response was yes it was...they said my bmi was not high enough during 3 years..she said she has sleep apnea!!! They said mail in hard copies..they would re-review so now I wait! She said if they deny again DrP will talk to medical director and hopefully that wil get approval..but hoping the approve second appeal! ..so hoping praying they will approve this time! I'm stressing OUT!!!i Ha!! Never been told I'm not "fat"enough! :/

I will say a prayer for you. I sure hope Dr P can work his magic.

Earlier in the day, I got a call from miss Margaret and I am in a bit of a pickle too. Tricare wants 2 months of Physician supervised diet. Five different Tricare Reps told me there is no such requirement anymore.

Well, now I don't have that, because none of my PCM's ever offered me such an option. I would just get the regular diet and exercise speech.

It starting to hit me hard, right now.

[joyaskins34 31]

I will say a prayer for you. I sure hope Dr P can work his magic.

Earlier in the day' date=' I got a call from miss Margaret and I am in a bit of a pickle too. Tricare wants 2 months of Physician supervised diet. Five different Tricare Reps told me there is no such requirement anymore.

Well, now I don't have that, because none of my PCM's ever offered me such an option. I would just get the regular diet and exercise speech.

It starting to hit me hard, right now.[/quote']

Well I was denied a second time yesterday because my bmi was not consistently 40 for 3 (was like 38 -40)years..even tho I have sleep apnea which is moderate to severe..it wasn't scored high enough to be considered a comorbid...so I guess I will no longer need this forum..I am to say the least devasted...they assured me I would qualify ..so 6 months and a lot of money paid outta pocket to get to where I thought I needed to be I am back to square one and deeply saddened , and just sick! Good luck to u girls in your journey to health and happiness in your own skin!!

[ArmyOfMe 82]

Oh my goodness, Joy. I am so very sad for you. You made me tear up. :hugs I understand the physical and emotional struggles obesity has put you thru. I just don't understand insurances that deny people like us, a chance like RNY to a healthier happier life.

I really don't know what is going to happen with me either. I am in God's hands, right now.

Not even Dr Pen's intervention worked? It did not weigh in with the board?

[joyaskins34 31]

Well Margaret mentioned on fri he would talk to medical director but I guess since she received the reason for the denial he won't now? ..I said to her "so is this it? Nothing else I can do" and she said" no I am so sorry I know it disheartening" she was very sweet but at the time nothing was comforting

[Jacqueline K 93]

Well Margaret mentioned on fri he would talk to medical director but I guess since she received the reason for the denial he won't now? ..I said to her "so is this it? Nothing else I can do" and she said" no I am so sorry I know it disheartening" she was very sweet but at the time nothing was comforting

Oh no! I don't think I would give up. Write an appeal yourself, maybe when they see you aren't going away they will reconsider.

I am going to call Margaret today myself to see if my insurance has responded. I am so nervous!

[joyaskins34 31]

I am going to call & write ... Let me know what she says..when I called I a Strong sense of dread so I can relate!! Lemme know!!

[Jacqueline K 93]

Yes, very nervous. She said insurance called her and left a snotty voicemail (those were her words) saying they have not yet received my pysch eval and until they have and reviewed it only then will they look at my claim. She didn't seem to think there would be a problem and she tenatively scheduled me for May 30th! She said she'll check back with them on Monday to see if they've reviewed everything yet. I am soooooo nervous!

My stomach is going to be in knots all weekend! I just know it!