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[sewingloss 0]

my doctor told me noe to loose much during that time because of that fact

[Jennifur 0]

Hi and welcome. This is a great place and I have had a lot of questions answered that i didn't even know I had. LOL

Anyway, call BCBS and they will give you the list of things they require. I have BCBS of RI and that is what I did, lucky for me my Dr. had the same requirements, actually think they required more than insurace so I hope I am safe. I am waiting for their approval but have my date set.

Personally, I am glad for the pre-reqs because I think I have learned a lot about myself and retrain myself prior to surgery. I don't think it is going to be easy but I do think I am much wiser about the choices I make when it comes to food.

Good luck

[Madam Bomb 0]

Well I called BCBS to verify details on my 6 month supervised diet. There is no frequency requirement so I guess I will talk with my PCP to see if once a month would be fine, not sure if she has her own requirements when it comes to supervising someone on a diet. I have an appt with her tomorrow and I have been running different ways through my head on how im going to bring this up. For some reason I'm really nervous about telling her. I just hope shes supportive...I really like her.

[Jennifur 0]

That is good to know, did they give you all the details of what they need? I had a huge list including a referral from my PCP recommending me for the surgery. I am holding my breath waiting for my approval from them, it seems like it is taking forever even though it has only been a week.

[Jennifur 0]

That is good to know, did they give you all the details of what they need? I had a huge list including a referral from my PCP recommending me for the surgery. I am holding my breath waiting for my approval from them, it seems like it is taking forever even though it has only been a week.

[Madam Bomb 0]

How did you get a surgery date before insurance approval? I just verified the 6 month supervised diet requirement. I have 6 months to work on the rest. I'll have a better idea when I have my consultation and thats over a month away.

[Jennifur 0]

Our program that I choose was very strict and has a long list of stuff that must be done before we can even meet with the surgeon, including going to a nutritionist while loosing a certain set amount of weight. Because of that they will schedule date 4-6 weeks out so they have time to get insurance approval and fight it before surgery. They had everything together for the surgeon to approve or disapprove and then goes to insurance and in most cases is not an issue.

I did have to write a personal letter for BCBS about who long my weight has been an issue (FOREVER!) and that I will not drink any alcohol for 1 year.

The hospital told me last year to call the insurance co and let them know i was doing this and see what they require to make sure everyone was on the same page, which is why they don't anticipate problems. It does seem a little backwards doesn't it?

[Jennifur 0]

Did I mention BCBS had the same huge list as my dr? Lots of test and evaluations. It took me about 5 months to get all of them done, which a lot of it was waiting for appointment dates, getting blood work and a bunch of silly other things that just took lots of time.

[Madam Bomb 0]

Wow, yeah....

I just called the surgeons office and scheduled a consultation. They said they would call my insurance for me and if there were any exclusions I would get a letter but if all was well I would receive a packet of stuff I needed to have filled out before our consult.

[Jennifur 0]

I had to do that too, the packet of stuff. My dr required a 10% weight loss which has taken a while, but insurance required everything else. I think that is why they do it like that so they have documentation to avoid denials, I started with some proceedures last Feb (06) and was done in August with all labs and things other than my last bit of bloodwork i did last week.

They are also doing a gall bladder ultrasound and ultrasound on my legs to check for blood clots as a preop requirement for the dr. only.

The good thing is, if nothing else, i have changed my eating habits and think it will make it easier post surgery?!

IT HAS BEEN A LONG YEAR!

[Madam Bomb 0]

Wow that is a long journey, I thought at first it would take atleast 5 months to get anywhere so atleast Im not that far off. After years of being overweight whats 6-8 months more ya know? Im curious if my surgeon will require a 10% loss since its something I hear often. Not sure how that will play out because I am borederline BMI qualified. I cant lose more than 19lbs or I will be under 40bmi but if he wants a 10% loss that 28 lbs.

[Jennifur 0]

I guess that would be something to talk to surgeon about, I am in the same boat, and he let me go by a few lbs but did say not to gain back any or i'm in BIG trouble. lol

I would have been there last fall but had some personal things happen that stopped the weight loss, and i'm glad now that I look back, Mentally, I am in such a better place and now ready and anxious!

[GreatGranny 0]

:clap2: I am 61 and just had my surgery on Feb 16. I started this last September. My ins had me go through a 3 month program. I had to see a physcologist, a nutritionist, visit my doctor every month (and they had to have my medical records for the last 5 years), and see a phyiscal therapist every week and work out 3 times a week. I weighed 266 lbs when I started and by the time I got approval for my surgery, I had lost 47 lbs. I finished the 3 month program on Dec 21 and got approval for my surgery on Feb 1st. The ins company did not have a problem with the fact that I had already lost so much weight and I don't have any healthe problems that would qualify me.

I have lost weight like that many times over the years but never been able to keep it off. That is what I hope the lapband surgery helps me with. I have lost 5 lbs since having the surgery 2 weeks ago and I'm not sure when my first fill is going to be. I think on March 13. Right now I don't feel restricted at all and the weight I have lost since surgery is because I am still dieting. I don't feel hungry most of time so it isn't really hard to eat right.

And by the way, I have a new great-granddaughter, just 3 weeks old.

If you have to do the 6 month program just remember that it is worth it in the end and it really passes faster than you might think. Talk to your ins company to see what their policy is if you lose weight during that period.

[GreatGranny 0]

I tried to answer this before but am not sure where my message went. I am 61 and have just had surgery on Feb 16. I had to jump through a lot of hoops for the ins company too. I am going to post this and if it works then I will tell you my experience.

GreatGranny

I think my first message finally got where it was suppose to so don't pay any attention to this one.

[Kat817 19]

I fought with BCBS of TX for what seemed like forever. They along with DH's employer's required a 12 month supervised weight loss program with bi monthly meetings with a nutritionist. Well I live in a very rural area of New Mexico, and we have no licensed nutritionists in network. So after wrangling over that for 2 months, they agreed to let me use my PCP for nutritional consult. So I did, he mind you continued to charge me a co-pay every 2 weeks for this...so I went, I began all my other testing. It all had to be done within the same time frame. I also gathered in all my medical records so I had everything in place to show a problem with obesity for minimally 5 years. I did my sleep study. I did my psych consult. I was on my way home from a check in with my PCP---down 43pounds---and was slammed into by another car. It wedged my left knee between the dash, and the door. I ended up having to have surgery on it. So between surgery, and rehab, I missed a 2 week check up....I WAS seeing a Dr....just not THE Dr. I happened to be in the hospital recovering from the surgery---but it STOPPED everything in its place. IF I wanted BCBS of TX to pay, I had to start my 12 months over, as it HAS to be CONSECUTIVE! I called, my Dr. called...always the same...start over. 10 1/2 months wasted. My insurance will only pay for the sleep study once every 2 years....it was all wasted. I would need a new psych study, new blood work up, everything! I had really been working the extra appointments, because I only had 6 weeks left....and because of a ditzy woman on a cell phone, she was trying to find a # so she could report a suspicious driver---he was weaving---and she didn't see us stopping, so she swerved almost around me, but because of the phone in her hand she said it caused the steering wheel to jerk around and nailed me down the entire side of my car, and pushed me into the car on my right. I was then looking at another year....talk about depressed. the weight started coming back on with a vengeance. Between the depression, and the lack of mobility with my knee. I appealled, and was denied. I started with my appointments again, found out insurance would not cover the visits again for the same purpose. Frustrating does not begin to cover it!

In the end----I received a settlement from the accident, and I took my money and RAN all the way to Mexico. My year anniversary from the last denial was last week. If I had continued to fight with them, I would still not be done jumping through their hoops---and that is only if nothing happened. As it was my DH had open heart surgery, then a massive GI bleed and was in ICU. If that had caused me to miss and appointment---it would have been screwed up again.

Instead I am down close to 90 pounds now...and getting close to goal. I take no prescription meds...my blood pressure is normal, my blood sugar is normal, and I have energy to spare. I'm just thankful I am no longer in the boat with you guys using all my energy attempting to satisfy the stinking insurance company.

Whatever you do DOCUMENT every little bitty tiny thing said to you, by who...what time....EVERYTHING!!!! I was never told the word "consecutive"---or I would have crawled out of my hospital bed....sorry it makes me angry all over again!!! I know you guys are just like I was, you work so your premiums are paid in good faith, you do all the stupid things they make you do, and they end up saving money---obesity is NOT cheap! But they do everything in their power to not pay. Part of me wished I had hired an attorney and forced the issue---the other part is just happy it is all behind me, and prefer to look to the brighter future!

There are some excellent letters people have written and are willing to share if you should get denied. Stay on them---you deserve this!

Kat