Need Help

March 3, 2005

I am just starting this process and I have Blue Cross of California which is where my company is and I work out of my home in Texas. I don't know what I am up against in getting approval, but one doctor's office I called said you had to document and have proof of lots of trying to lose weight, including a 12 month weigh-in with a physician in trying to lose weight. I haven't done that in years! And don't even remember the doctors I did it with in the past.

If you can share with me what you documented for the insurance company I would appreciate it, as well as who did you surgery if you are from the Dallas/Ft. Worth area.

Thanks!

Deby

March 3, 2005

I did not use insurance for my Surgery, but I can tell you the Doctor I used was just fantastic as well as all of his office staff. His name is Dr. Jayseelyn and his office is at Medical city. I have been very happy with him and I have had great results.

Vera · March 3, 2005

Please keep us updated. I have Blue Cross of Calif. and was denied. I've heard they've changed there policies lately, so I wish the best for you.

Sorry, I can't help you with any documentation, I was self-paid.

Good Luck

New Hope · March 3, 2005

Deby, have you contacted your Benefits Coordinator to see if WLS is covered? You need to specify "gastric adjustable band", not "gastric bypass". That should be your first step.

Then, if it is covered, the more info. you have the better. My surgeon has an excellent pre-op questionnaire on his website. It is pretty thorough and lists things that you might not have thought of. Here's a brief summary of the things he lists: your surgical history, social history, family history, current medications (and dosages), numerous symptoms, and dietary history. I'm including his website so you can check those. He lists several weight loss attempts that you might not remember or would have considered.

www.lap-surgery.net . Best of luck to you on your search for better health. Please let us know how things are going.

La_madam · March 3, 2005

i got blue cross of california and there was no way they would cover me. i had no health related issues from my obesity so i hope you have better luck

leatha_g · March 4, 2005

I used Dr Veninga in Carrollton.

I did not have to have such rigid weight loss information. I simply wrote down all the previous attempts, such as Diet Center, Nutri System, Weight Watchers. How long I was on them, how much I lost, how much I gained back, etc. Things are tougher with other insurances. I wish you luck!

La_madam · March 4, 2005

Hi Deby,

You have blue cross of california and live in Texas?

I live in California and have Blue Cross PPO

There was no way I could get them to cover my surgery. I tried like heck , but to no avail, I did supervised diets with my doctor so I went to Mexico and self paid, and glad that I did. If Itried to appeal with my insurance company I would probably still be fighting them, but now I site here 80.5 lbs lighter 11 months later. So I am happy with my decision. I wish you much success with getting them to approve you

March 4, 2005

Thank you for the information. Yes, the company I work for is in California, that is why BC of CA. However, I think they use the Texas guidelines if that makes a difference. I am going to try it. Not sure I can afford self pay. Can any of you share the average cost of the surgery if self pay? Also, does anyone know of a Dr. McCarty in the Dallas/Ft. Worth area? I am going to his seminar at the end of the month and they verify if your insurance will pay before you even see the doctor after the seminar if you wish to go forward with them.

New Hope · March 4, 2005

Whether you decide to go w/ Dr. McCarty or not...those seminars are so helpful in your research!

Each band dr. has a different price, so you should contact them direct or see if they have a website for accurate information.

DeniseG · March 4, 2005

I know BCBS of TN as of last year didn't pay for it. The weird thing, you can get a Tummy Tuck and boob job lol with their insurance, but, not the Lapband

March 7, 2005

The thing that really gets me is that these insurance companies will pay for knee replacements, therapy for bad backs, feet/ankle problems, etc, but won't pay for something to stop the problems from happening. Boggles the mind! I go to my seminar with Dr. McCarty on the 30th and will then see if I can get BC to pay. If not, I am going to see if I can afford to do self-pay. Thank you all for your help.