Not cleared for Surgery...

frogladyaz · March 27, 2008

:confused:I applaud those of you who have waited many months for insurance; I am now joining your ranks! I decided that I was too scared to wait 8 months (I, too, have BCBS...what if I was up another 50 pounds!) so I managed to wrangle $17,000 and was scheduled for surgery today. My LapBand center (TruReslts in Scottsdale) told me that I could easily schedule for 2 weeks out and get the necessary clearances. The last two weeks have been a crazy juggling of appointments around my already crazy work schedule, and yesterday at 3:00 I was still trying to get the cardiologist to fax the results from my NUCLEAR Stress testing. When I finally accomplished that and thought I was cleared, the TruResults people told me that my sleep study results came in that day as well, and I have something called "moderate obstructive sleep apnea with a severe component during REM sleep" and that the CPAP didn't work for me. NOT CLEARED FOR SURGERY. So, the surgery today is cancelled and I decided to hell with this....since I have to deal with some more of these health issues first, I sent back the $15,000 I borrowed and I will just be patient and go through the insurance hoops. Here's a question, though...if I lose just 60 more pounds (done it before, and now I have the health issues to prompt me) my BMI will be 35...another few pounds and it will obviously be less. Then I would not qualify for the banding, but my history is to know how to take it off, but not keep it off. This can really "mess with your head". Oh, yeah...I've been on this 3-Protein shake a day pre-op diet, and now have to return to eating.

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Brandy~ · March 27, 2008

Even after losing that weight you should be just fine with insurance. I have BCBS of Minnesota and was told they use the weight from your initial consultation. The fact that you have a comorbity helps... it's not reassuring to have a health problem but it is a plus when getting approved for the surgery.

I too have done what you did I had the money for the surgery but decided to go through wtih the insurance hoops I am almost done with the hoops!! Then I will use the money to reward myself when I hit my goal weight :tongue_smilie:

srknepler · March 27, 2008

Was your sleep study one night or two?

When my DH was going through his first sleep study, they told him that they would do a second night if the CPAP didn't seem to work for him. Just to be sure.

I'd ask for another study. It couldn't hurt...

luluc · March 27, 2008

...if I lose just 60 more pounds (done it before, and now I have the health issues to prompt me) my BMI will be 35...another few pounds and it will obviously be less. Then I would not qualify for the banding, but my history is to know how to take it off, but not keep it off. This can really "mess with your head".

call bcbs directly and get a copy of your policy - as it pertains to bariatric surgery. each one is different regarding requirements / tests / etc - and it's best to know exactly what your end of the arrangement will require.

i was denied by bcbs tx w/a bmi of 36 & ended up going self pay w/true results rcdn tx.

i agree w/you - i can loose the weight, the band however is a reminder that you can "KEEP" it off long term. i wish you well!!

neverB4 · March 28, 2008

You do have to be careful with BCBS. I work for BCBS of SC and it does depend on what your contract says. I deal with individual policies and small business...NEITHER pay!!! It is interesting, though, to see how many other states of BC do pay. They won't even pay mine as an empolyee-ha!:confused2: