Feeling a little beaten-down

[Dee66 0]

Hi everyone. I had my first appointment yesterday with the bariatric advisor. This was really the first step in my journey. I loved the girls at the front desk, they were so helpful and kind. The advisor was really nice too but the only thing is that I feel like I am hitting brick walls and I haven't even begun yet! She had told me that in addition to the letter of medical necessity (which I had already gotten) I needed to have 6 months of medically supervised weight loss records! This is kind of a let down since the only plans I have been on are the ones on my own (WW, Nutri-system, Jenny craig, etc.) Apparently, BC/BS has changed their policy as of jan 08 and this is what they require. I feel a little beaten down because I really thought that YEARS of documented weight loss and receipts for hundreds of dollars worth of pills and programs would have been enough. If anyone has any idea's as to how I can get around this or any suggestions PLEASE let me know. I truly appreciate it cause I am feeling a little beaten down right now. Thanks

[faithmd 14]

I'm sorry you have had this disappointment. It stinks, it really does!

But no, there is no way around it.

I had to do TWELVE months of MD supervised diet therapy.

Make an appointment today with your PCP, right now, this very instant. And then make subsequent appointments for every month as soon as you can. You'll need seven of them (at least). DO NOT MISS ONE SINGLE APPOINTMENT. If you do, it's back to square one.

Make sure that not only do you see the MD at each appointment (no, a nurse visit with a weight will NOT count), but that your weight is recorded and that the MD puts in their notes what you are doing that months to lose weight. Something as simple as them saying in their note that you are walking three times a week for 30 mins, or you have cut out all refined carbs, or that you are walking the stairs at work twice daily or that you are giving up soda will help.

Many insurance companies will not merely accept a letter outlining this from your PCP, they REQUIRE the actual OFFICE NOTES from your monthly visits, and those notes must contain discussion of your weight loss.

Call your insurance provider yourself and ask for a copy of the specific requirements for Adjustable Gastric Banding coverage be sent to you so that you have them in hand to refer to.

Many of our journeys are months or years long. If you have the resources and do not want to wait, you could always consider Mexico . Many many of us have been/are being banded there. There's loads of threads about it.

We're here for you. Feel free to vent anytime.

[ThinDolphin3 3]

What branch of BC/BS do you have or is it all of them?

[faithmd 14]

I can't speak for the OP, but if you have BC/BS and don't have the requirements yet, please call them right now and ask.

Many people can have the SAME insurance company, and sort of the same policy and one's requirements may be different from the other because of riders their employer may or may not have purchased. That's why I always advise EVERYONE to call your own insurance company, and have them look up YOUR policy and then ask them to explain what the requirements for coverage for Adjustable Gastric Banding is, then have them send you a hard copy. And write down names.

[Dee66 0]

I have BC/BS direct Access. I thought this was one of the best plans that they offer but I guess they are really cracking down. The PA told me yesterday that this all started on the 1st of the year (just my luck 3 weeks later)!

[gisellehuet 1]

I completely understand how you feel.. It took me months to make the decision to have the surgery, then I had to wait 3 months for my first appointment. And unlike your experience the personnel was not very kind. But yes I found out of all the "new" requirements that I needed before they could tell me if BC/BS would approve the surgery! I tried to get around it, especially the 6 month supervised weight loss, but there is no way out. All these requirements are going to take a long time... I can tell you it is very stressful and at times I just wanted to put all these behind and forget about the surgery... But beleive me you just need to learn how to be patient...I finally got approved after almost a year after my 1st appointment, and I found out because I called the insurance company, I still have not received the letter yet. NOw I am waiting to set the date and go for all the pre-op stuff. The waiting period is really hard... but during this long time of waiting I learned more about myself and my eating patterns, I have grown stronger emotioanlly, and I think that all these will help me after the surgery. I like to think that the surgery will happen when it has to happen, not before not after, just at the right time.

Take it easy..

[Dee66 0]

Thanks everyone for their input. Trust me, all day today I kept hemming and hawing about pushing on. I decided that there is NO WAY some insurance company is going to knock me down with all the money I have given too them over the years! I most likely could have paid for 2 surgeries if I added it all up! I called my PC doctor and requested ALL 5 years of my charted weights! That was ALSO another thing BC/BS needed. I also took the advice of Faithmd and made an appointment for the first week in Feb. I had an appt on Jan 14 so I will go every month also. There was one really interesting thing the PA had said too me when she mentioned that BC/BS needed these weights. I had remembered today that back in the 1990's I had attended Opti Fast through a local hospital. When I called she had said to try and get the records because NO WHERE in the requirements did it state that it had to be within a certain time period. She also said that could be an argument with BC/BS. I actually read the requirements and it didn't say that it had to be recent. Now, hopefully the hospital will have these records! I will keep you all posted. Thanks:smile:

[make33 2]

I totally understand the disappointment--I was too last March when I learned that UPMC required six visits to a nutritionist. I was borderline on the BMI and I thought "What if I lose just enough weight to bring me below 40?"

My advice to you is to look at this like the opportunity it is: You have a great chance to really study what your future will be like. You can prepare for the foods you will be able (and not able) to eat, dealing with the Band's rules, and all other aspects that will totally involve your new life.

The insurance company is paying the bill, so I'm sorry to say they call the shots. So do what I did: make the very best of your time. Believe me, it WILL fly by and soon enough you'll be post-op! :smile:

[ConnieC 0]

Suger dont let it get you down!!! Just jump through their HOOPS and it will happen befor you know it. I started the HOOP jumping in April 2007 and it was the end of Oct. 2007 before it happened!!. Emotions are going to run high, but it is worth it all!! Hang In There!!

Connie

[ladybug97 0]

I have BC/BS too. My policy states that the six months of supervised diet can be WW, jenny Craig, etc. Well, once doc submitted the letter of medical necessity along with my six months of WW documentation BC/BS said that the six months of supervised diet with WW HAD to be accompanied with six months of dr. visists regarding my weight loss efforts too. So basically, I would have had to pay for six months of WW and pay to see the doc at the same time.

Luckily they submitted the letter soon enough that I didn't have to re-do the entire six month process. I chose not to do the WW at all, just stick with the dr visists. They submitted again after six months and I was approved. Now I am just waiting for a date.

THe only advice that I can give you is to keep your head up. The six months seemed like a lifetime for me too, but it is worth it.