Hi Guys sort of new here.

HI guys

I am back after a 2 year absence.

2 years ago I went through the process for Gastric Bypass I had a surgeon/hospital picked out and went through the seminar and the pysch exam. Which I passed both.  The denial came due to the 6 month medically supervised diet and my primary doctor.  The doctor I had at that time thought he could cure everything through medication. The only medication that I had was for blood medication and a water pill (which according to him was to reduce my weight).  I am currently at 440 lbs and a bmi of 59.x.

Anyway I have had 4 stays with a possible 5th stay in the hospital in the last 15 months due to infections in my leg due to celluttis.  I do everything they tell me and they still go bad.  Its getting harder to walk long distances without a couple of stops... This all goes along with the high blood pressure and using a bipap machine.

So heres the story.....  Last Wedneday I changed doctors... This time I chose a doctor who specializes in obesity and hypertension.  This doctor I think is going to be a blessing in disguise.  During the initial visit she suggested that I think about a GBS I followed up and stated that I went through the process and was denied to the diet. 

So here is where the questions start.  Her response was with my weight problem and high bmi and other problems that I may now qualify without the diet and BCBS has changed their requirements for the super obese and that she is going to go ahead and refer me to the surgeon of my choice... She thinks this can move pretty fast..

I have tried to research the net for horizon BCBS and their policies and have found documents that show change since my denial.. Does anyone know or understand these changes.  Is she pushing hopes that this may go fast as I am tired of these hospital stays.  I am confident that I have the right doctor that will work with me this time.  So I am ok either way.

One more piece of info I had a 10 day hospital stay for a staph infection.  When I got home I had a call from a case manager for horizon BCBS and she looked over my history and asked why I haven't looked into WLS I told her I had applied and was denied due to the diet she stated " Get youself better with your legs and call her back ans she thought she had enough info to help me get the gastric.  My  legs were straightend out  and I called back and no one knew who she was.


I JUST DON'T KNOW WHO TO BELIEVE ANYMORE.

Any tips or help would be greatly appreciated
Thank You for any help in advance

Bob

I don't know anything about BCBS, but it sounds like your current PCP does- so trust them and let them help you through the process. I'm sorry that you didn't push the denial, just because you were denied once doesn't mean you can't get your surgery.

Many insurance companies deny people 1 or multiple times, before they agree to do the surgery. You deserve this surgery- be persistent, keep asking questions and stay on top of your doc and all the paperwork.

Have you looked into all 4 of the surgery types? What are you leaning towards?

I wish you much luck and healing with your celluttis- I hope that you get your WLS very soon!

:Danni

I have BC HMO.  I know each plan is different.  I have to have 3 nutrition vist and a psych eval to get approval. I didnt have to do a 6 month diet.  I called my plans 800 number.  Thye were able to tell me what I needed to qualify for the surgery.  Good Luck.

Hi guys

Thanks for the replies. 

I guess I was so disgusted with the last journey and the work put into it only to be denied.  I think this journey will be better.  I have a PCP that is willing to do what she can to help.  I just talked with the surgeons office and they are talking with BCBS to see what is needed .  So it looks like I am officially back on the trail.

Once again Thanks for your help

Bob

Each BCBS plan is different also.  I live in TN, but my company uses BCBS of Alabama and as of this past year, they still required me to do the 6 month medically supervised diet.  BCBS of California covered the Sleeve surgery a year before BCBS of Alabama did, also.

I believe the surgeon or your PCP can pu**** through in some cases, though, plus it may be completely different based on your own plan.

I've also heard that they nearly always deny the first time and usually approve after an appeal.  I don't know how true that is, but it happened to me as well.  Mine was denied because I had 11 months that I didn't see a doctor so I didn't have my weights for that time to prove I was overweight...nevermind that I gave them the 2 yrs before that and 2 yrs after that time!  As if somehow I'd lost and gained 150+ lbs in a matter of 11 months!

I wish you the best of luck!!!
Jen