Waiting for insurance approval

Apples2 · February 7, 2008

I am on pins and needles waiting for insurance approval from BCBS of Minnesota. Was told by my doctor's office manager that I would hear within 14 days. All paperwork was submitted on 1/29. Got a call yesterday saying that they needed some sort of documentation to prove that I actually had tried a diet plan in the last couple of years. (For some reason there were very few weights documented in my clinic file over the last 10 years...even though I discussed my weight issues with my GP numerous times). Was able to find a receipt from NutriSystem and provide it for them.

Anyway, since that phone call I have been in a panic thinking that maybe the insurance company won't go for it. I know I should be patient and think positively. I was told last night by doctor's office manager that I should hear by Friday. I can't sleep and feel sick to my stomach.

I know that this surgery is the best thing I can do for myself. All I want is to live the rest of my life healthy and to be able to do all the things I used to do. Is that too much to ask for? I know the band can help me keep my eating in check and that can only be a good thing. Just need to get through today and tomorrow.

robint · February 8, 2008

Hi Lilo,

I also have BCBS of MN. I am currently in the 6 months pre op. program. I talked with them several times along with my doctors office and they sound positive as long as you meet the criteria. I am curious to see if they will give you any problems.

Apples2 · February 8, 2008

Nice to talk to another MN person and wish you luck with your pre-op process. How many months are you into it? My doctor just had me do a three month. Started Nov 12 with my first visit to him. Weighed 236 at the start. I am down 36lbs in the three month period. Should hear from his office manager today whether they will approve or not. Think I am a little nervous this morning?

I have co-morbidities but none that were documented in my clinic file except for high blood pressure. Had talked to my GP about joint pain, family history of diabetes and heart disease, etc. and a couple of years ago talked to him about getting into the lap band program. Again, nothing documented. So my dilemma is that there's not enough documentation for weight, diet plans tried, when I would visit my dr. and talk about just how my weight had affected my health. My surgeon tells me not to worry and he thinks it won't be a problem since I have done so well in the last three months. He documented all my co-morbidities and sent them to the BCBS. They contacted his office earlier in the week and were questioning what diet plans I had tried in the last few years and wanted proof. That got me thinking and scared that they were going to turn me down.

Just need to get through today until I hear something. BCBS might just make me do the full six months. There are worse things. My surgeon is so confident that they will approve this week. We'll see. I will keep you informed.

Apples2 · February 8, 2008

Forgot to ask. Who is your surgeon? I'm with Dr. Fortier. Felt as if I could rely on him as soon as I met him. I have had good feedback on him

Lizalee · February 9, 2008

OK, so Friday's almost over...Did you hear anything? I have to wait probably 3 or more weeks before I will find out - they submit next Thursday, then a week for reply, then a week for Dr.'s office to call -- it's killing me! Hope you heard something!! I know how hard waiting is!

Apples2 · February 9, 2008

Hey Lizalee, Well, waited all day and could hardly take it any longer. Emailed my Dr.'s office manager to see if I was going to hear anything today. Denied. Denied on the basis that BCBS would like to see me do the whole 6 months instead of just the three. Now I need to continue on and my paperwork will be turned in again in three months. :angry: The nurse did state that they did not turn me down because of any other factor...just tht they want me to do the entire 6 months. My dr. was so sure on Tuesday when I saw him that I would have no trouble getting approved after the three months. As far as I know, most of his patients to get approval in that time period. I am not sure if I will have to see the nutritionist, psych, etc. all over again. I am supposed to be getting a letter from my ins. co. shortly (never know when that will be).

I was upset for a bit when I found out but just emailed the nurse back saying I was ready to continue with the next three months. I am in this for the lifetime benefits so what is three more months? I just hope that I can continue to lose and be proud of how I am doing. I know that I am going to try as hard as I did the previous three months. I am not going to get discouraged. I actually am surprised at how at peace I am with their decision. I appreciate you checking....I guess that's what we are all here for.

I have relied on this sight the last week to get me through some things and I have certainly appreciated everyone that I was able to talk with. :thumbup:

Apples2 · February 9, 2008

Lizalee...forgot to add...good luck with your approval. Please do not become at all discouraged by my denial. It will happen for me. It's just going to take a little more time than expected. Please keep us informed. I'm pulling for you. Every situation is different.

robint · February 9, 2008

Lilo-

I actually live in Louisiana. My corporate office is in MN. BCBS told my doctor's office about what they needed in order to be approved. My doctor's office requires 6 month pre op so BCBS will approve with no problems. They are very familiar with BCBS. I just started in January. I have joined Curves for exercise, met with my general pract., met with my surgeron, met with a dietician, and waiting on psyc. appt. I have monthly weigh ins at my doctors office. They told me today that the more information they have documented in the six month period, BCBS approves with no problems. Also my doctor's office required that I get a copy of my medical records from my general pract. showing my weight from the last 5 years. So you might have to do a 6 month program instead of 3. I know 6 months seems like a long time. Good Luck

Apples2 · February 9, 2008

I had the feeling when you talked this morning about BCBS requiring 6 mo., that I would need to follow that guideline also. Not a big deal. Will just do it and smile while doing it.

I also dug up everything I could but was really short info in my files. Mr. dr. just didn't document when I would come in with weight concerns. He would document that I had joint pain but would not refer to my weight. He would document my acid reflux but would not refer to my weight. He would document that I was increasingly getting more tired everyday but did not document anything to do with my weight. Just frustrating.

I am willing to do anything I need to at this point to get the approval. I am really going to hit it hard, lose more weight each month and go for the approval again. Good luck with yours...hope you are approved on the first try.

robint · February 9, 2008

Thanks and Good Luck to you too.

krazygrl77 · February 14, 2008

I'm from louisiana.. but i have United Health Care. I'm going to have to go to New Orleans for my surgery.

girlie2shooz · February 14, 2008

i have bcbs nevada and i had approval in 6 working days. bmi of 34 so look to the positive side!! i thought i was a long shot but it worked. best wishes and good vibes.

vessa · February 14, 2008

I had BCBS of MN too, I went to mayo and they made me go through the whole 6 months, did all the paperwork, an I got the approval in about 10 days. Iremember GAWD I hated waiting so bad! It was forever at the time! Now it is all long past, an it actually was short compared to the trial afterwards, learning new ways to eat and such. Mayo tol me BCBS of MN was fantastic for approval, and the fact that you didn't get denied right off, makes me think they will approve you very quickly when you send in new paperwork, as they will see you are truly commited. Good luck, I know it feels like forever, but everything changes when you got it, so try to enjoy the things you wouln't right now if you were banded (like a huge salad with everything, and some ribs!)

Apples2 · February 14, 2008

Vessa, thank you for the support. Just going to plug away at these next three months and be happy for the opportunity to even have this surgery. Thank God for the Lap Band inventor!