I'm Back......and DISAPPOINTED

[Tracyde730 7]

Ok, I attended the mandated seminar today and now I'm 110% sure i want the Lap Band. I learned a lot and I'm not scared any more of the surgery or the anesthesia, but.....I am disappointed. BC/BS requires a 6 month doctor surpervised weight loss/ suggestion plan. That stinks!! I have a question...I've been seeing a Psychiatrist for years who has prescribed meds for me to lose weight and knew I was on WW, but nothing worked. Can he write me a letter? I wouldn't be once a month for 6 months but it may be one every 3 months for a few years. Do you think the ins would accept that? I know he'd write me a letter.....HELP???!!!

[rottimom 0]

I am in a similar boat. My PCP wants me to do 6 month program with a dietitian. I think I will have to meet with them once a week. Only problem is I cannot get them to return my phone calls. Maybe if you have a high BMI and medical conditions they will take that into consideration.

[NikkiD 0]

I also have BCBS and am required to follow a 6 month supervised weight loss program. My understanding is it has to be 6 consecutive months where your weight loss and diet are documented. My surgeon is actually part of a weight loss center that has dieticians, excercise trainers and therapists all in one office. Feb. 25th is my last month so i'm almost there. I understand your dissappoint but try to look at the positive. By doing this it will help you adapt to and understand the lifestyle changes you will have to make after you get banded. You will learn the right foods and the right amount of those foods to eat. It will also get you into the habit of excercising if you aren't already. Take full advantage of this requirement its not all bad.

Good luck!

[Tracyde730 7]

I do have high pressure and I'm on meds for it, plus I have a family history of early death do to heart disease, but will that matter?? My BMI is like 38.8. This process sucks!

[IM_LORI 0]

Look around online. There are docs that have 6 month diet journals they will provide it for you to insurance. And ask here too. Someone is bound to have one that they'll give you. It's a minor technicality that you can work around.

[favorite 3]

i had to see a dietitian once a month for 6 months. that seems to be the norm for most insurances. but i do know people whose doctors gave them letters that they were under his care for 6 consecutive months with all the necessary info the insurance wanted and speeded up the process. good luck the band is a God send.

[Tracyde730 7]

Thanks Lori....Any one have access to 6 month dit journals or know of a doctor who does??? LOL

[Dressagerider 0]

Hi, I'm brand new here, this is my first post. I am 7 days post op and have BCBS.

And BCBS covered my surgery.

My GP first suggested this surgery back in June. I have high BP, high cholesterol, suffer from joint pain and depression........all due to my weight. Also was backed up by my Cardiologist at my first visit with him. He documented (in Oct. 07) that he agrees this surgery would of great benefit.

I, too, was only (funny, huh.....) at 37 BMI.

My surgery was scheduled from Feb 7th. I had all my ducks in a row when BCBS decided to change their requirements, first to medically supervised 6 month's weight loss, then to a supervised wt. loss program.

I contacted my state's Banking and Insurance organization and started a claim that BCBS changed their requirement mid stream and with no notice.

In the meantime, I did supply receipts for food purchased from Nutri System and had letters from both my GP and Cariologist.

My GP's office did a summary of my weight battle for 8 years.

I was approved the day before the surgery was scheduled.

Don't give up! Don't leave any stone unturned!

[Tracyde730 7]

Thanks Dress! Believe me, I'll be on the phone tomorrow getting all the info & help I can. Good luck and congrats to you!

[Maya314 0]

Ok, I attended the mandated seminar today and now I'm 110% sure i want the Lap Band. I learned a lot and I'm not scared any more of the surgery or the anesthesia, but.....I am disappointed. BC/BS requires a 6 month doctor surpervised weight loss/ suggestion plan. That stinks!! I have a question...I've been seeing a Psychiatrist for years who has prescribed meds for me to lose weight and knew I was on WW, but nothing worked. Can he write me a letter? I wouldn't be once a month for 6 months but it may be one every 3 months for a few years. Do you think the ins would accept that? I know he'd write me a letter.....HELP???!!!

Hey Tracy! I was 2 weeks into my 6 month nutritional counseling.. blah blah.. and then was told that it was no longer a requirement I also have BC/BS, this was back in December.. maybe early January.. So I'd definitely look into it, they may be working on what used to be the requirement. In the mean time I'd get every little bit of records you can together for them to submit your authorization including your psych stuff and ww stuff to help your case.. Good Luck!

[shortgal 5]

Just FYI,

two people can both have BCBS, but unless they have the same employer, their benefits might be different. This is because each employer has a choice of plans (with different coverage) to choose from to purchase for their employees.

So you need to check the requirements and coverage your employer has purchased.

And you might find some threads in the "insurance" thread on the forum.

I went to the seminar in Feb 07 and had all the pysch and nutrictional appts done by April and didn't end up having surgery until November and then I self paid. I was tired of the runaround from the ins. co.

The process can take time. Good Luck!

[valvinnek 0]

I started my process with my nut. counseling in May. Last year BCBS of Michigan required 12 months of the counseling then the first week of January my surgeons office called and said that its now only 6 months. So I had already completed my requirements. Just be thankful its the six months rather than 12.

[LilMissDiva Irene 3,282]

I do have high pressure and I'm on meds for it, plus I have a family history of early death do to heart disease, but will that matter?? My BMI is like 38.8. This process sucks!

Hi Tracy,

I have High Blood Pressure and my BMI topped at around 53.4. I made it through the six months dietician appointments and all the other requirements necessary to get in the hospital room. I just had my surgery on the 11th. I am right now weighing in as of this morning 279 (BMI 45.1), however I only record my weight once a week.

Someone mentioned not many posts ago that these appointments are important. I wouldn't even say that, I'd say more a detriment. You have to prepare yourself for the upcoming. You need to learn new ways of thinking, and eating. All this is so critical to achieving the goals you will have to face. This is no small deal, so please don't treat it like it is. You should not act like this surgery is a drive-thru, as you see where drive-thru's have gotten you right now.

I'm sorry if I sound kind of harsh, but it is the reality. Go to your dietician appointments, and by the time your are nearly done, you will definitely agree it was the right thing to do. You will get so much more out of it than you do in a two hour seminar.

[luluc 6]

Good for you Dressagerider!!! DH and I "had" BCBS, and after them too changing their requirements midstream - we quit and worked out a plan to self pay for the both of us...I never thought of contacting the Banking / Ins Org - brilliant idea. Hope others going through the same thing see this.

Tracey - I'd contact your insurance directly and ask what the parameters are specifically as it applies to you for WLS..Good luck!

[Tracyde730 7]

I called my ins this morning and they were very vague, but I specifically asked about the 6 month plan and all the lady kept repeating was "talk to your doctor & get a note"....well, I have a PCP appointment next week and I'm making my Psychiatrist appt later for ASAP. Thie may work after all!!