I just can't believe it!

[SassyTink 78]

P.S. I have crossed my "T's" and dotted my "I's" as far as following the guideline BCBS sent me initially. I also have, osteoarthritis of my right hip, severe sleep apnea and am pre-diabetic. The co-morbidities are there. We shall see what new reason appears to deny me.

[Beach Lover 1,084]

Tbird49

I do not have the exclusion to my policy, somebody at BCBS was not being very thorough. I will be approved, there was never a reason to be denied and that is why I was in such shock. I am still weary until I get the APPROVED and date from my Dr.

I am so happy to hear that everything is working out! I know you will feel better once you get your approval but it sounds like it is just a matter of time!! You go girl!!!

[Stacy_wls 135]

Good luck!

The insurance is so frustrating. I have Cigna, which covers it, but my employer has it excluded. I was 'lucky' in that a co-worker went through the stress to figure this all out last year, so I got to skip it, but am stuck paying myself. Less emotional stress, just more financial.

I hope this goes through quickly for you. I am having my surgery on dec 9th, maybe we will be around the same time.

[Seela 1,187]

I am so glad you got mad enough to fight for yourself. I have no doubt if you keep up that tenacity that you will not only be sleeved but you will do great! Good luck!

[SassyTink 78]

Today, Monday November 11, 900am, after 8.5 months of working on getting sleeved , I was approved. There were big mistakes made at BCBS of Illinois which lead to my denials. After nine calls to BCBS, two denials, working closely with the representative from my Bariatric Center, getting a benefit advocate from my companies Human Resources Department, and being very tenacious, it finally came through.

Now, it is going to take a few days for my Dr's Office to get the approval in writing from BCBSIL but the office did call BCBSIL to get the approval. I have to go to the pre-op class and then I am set.

My advise to anyone that is denied VSG Surgery is to make sure that they get a copy of their policy and the exclusions. 8.5 months ago I was approved to begin the program so this denial came out of the blue. My file became more complicated after the denials. Erroneous information had been added to my file that were not part of my policy. Unfortunately the representatives at BCBSIL read the incorrect information and kept telling me the procedure was denied.

Thank you for all of your support everyone. I guess working this hard to get approved really makes me understand the importance of this surgery for me. It gives me, and everyone else that suffers from obesity a chance to have a wonderful, happy, healthy, longer life. Two weeks ago my hope for a healthier future was dashed. Today I am smiling from ear to ear.

Again.......it is a go!

[peachie86 63]

I am so glad you advocated for yourself! Please keep us updated.

[SassyTink 78]

November 22, 2013 100pm.............................it is official!!!!!!! I am over the moon.

[Seela 1,187]

November 22, 2013 100pm.............................it is official!!!!!!! I am over the moon.

I couldn't be happier for you! ! And you got that November date you were hoping for it's gotta feel good knowing not only did you make this huge decision for yourself but you fought for it and you won! You've barely started your journey and your already and inspiration!

[SassyTink 78]

Seela

Hopefully, my two denials will give others the strength to fight their insurance for their surgery as well. If there is an exclusion to your policy, there is nothing you can do. My only suggestion for that is, make sure there is that exclusion. For two weeks I kept hearing, "There is an exclusion in your policy". Finally, I said,"Read it to me, because I have a copy of my policy and I don't see that exclusion". Get a copy of that exclusion. They couldn't read it to me because it wasn't there. The second issue I came across was misinformation in my file. Somewhere, after my initial denial, a biliopancreatic diversion was listed as my surgery. I still haven't received a straight answer on where that came from. My Dr was extremely thorough and documented our two visits with the Vertical Sleeve as my surgery. Both of those visits were covered by insurance.

These last three weeks have been a roller coaster for me. Now, more than ever, I am positive that I am ready to proceed with the sleeve. I am nervous, scarred and a little anxious. After all, I am embarking on an exciting new way of life. If I didn't take it seriously then I wouldn't understand what this procedure is all about. It is no quick fix it is a life changer.

$25,000.00 richer........thank goodness for insurance!

Me

[Rena's got this 274]

I'm so glad for you! Your tenacity in continuing to fight for what is rightfully insured is inspiring. You only have a week and a half left before surgery! Do you have to do some kind of pre-op diet?

[SassyTink 78]

Rena

Anticipating a positive appeal from the insurance I began the pre-op diet two weeks ago. (After a frustrating two days of splurging after the denial) My surgeon does not require fasting, just high Protein and vegetables, low calorie. I have been doing 2 Unjury shakes a day and 3oz meat and tons of veggies for dinner. It is tough but I feel pretty good. Nothing was going to get in the way of this surgery!!

Are you sleeved yet or awaiting your big day?

[Blondiee 278]

I'm so happy to hear that everything worked out for you!

[Rena's got this 274]

My surgeon forwarded my paperwork to BCBS of Alabama on Nov. 11th. Supposedly they have 30 days to reply, so I'm not going to get my hopes up for a sleeve date by the end of the year. I'll just keep plugging along.

My surgeon's office says they are booked up anyway through Christmas. Bummer. I have a lot of vacation time that I need to take between now and then, and it would have been the perfect time for me to get sleeved.

[SassyTink 78]

Rena

Actually, BCBS was really quick on the reply......it was just a denial!!! They are normally pretty efficient. Are you sure the Dr. can't fit you in anytime before the 1st of the year? Psychologically it would be such a relief.

Sassy

[ProudGrammy 8,322]

November 22, 2013 100pm.............................it is official!!!!!!! I am over the moon.

SassyTink

WooHoo, Woo Hoo!!!!!!

party dance, party dance

being so pro-active, persistant - way to go!!!!!

next friday WLS???

holy moly

those feelings your dealing with - nerves, excitement

totally normal

those feelings will increase over these next few days

you made the wise decision to have this life changing surgery!!!!

don't 2nd guess yourself now, of after the fact

if you continue to work as hard as you did before surgery, as you will now -

wow, what a success you will be!!!!

by the way, damnnnn those insurance companies

good luck

speedy recovery

kathy

what a success you will be/are

i have confidence, i know you will do great