I'm approved!

I just got the call that insurance approved my surgery. They actually approved it the SAME DAY that they got the pre-authorization submission from Surgical Associates! Yipee!!!!! I'll keep you posted as things progress! Jillybean

Congrats to you!!

Congratulations Jill. Hawkeye Mike

Thats fantastic. We started trying to get approval around the same time. I'm glad one of us is getting somewhere. YAY JILLY!!!

Congrats Jill. I see in your profile that you have BCBS Alliance Select. I do also, and my plan says "You have a documented history of failure to sustain weight loss with medically supervised dietary and conservative treatment for at least three years, including within two years before surgery." Did yours say the same and if so do you know if they require 3 years of monthly visits for dieting, like some of the other plans I've seen people talk about. I'm really hoping that 3 years of being medically supervised for co-morbidities while dieting on and off, will be enough for them. I hate to think that I have to try and diet for 3 years going to the dr every month for 3 years to have the surgery. The reason I need the surgery is because of the co-morbities, like all of us. Thanks for any info you have.

Hello, I have the very same insurance with the same requirements and I am just as curious. Can you answer it for me as well?? Thanks Velda

To answer the question about BCBS Alliance Select, the policy reads as follows, however I have documented weight loss attempts for several years, the last major one less than two years ago I did Optifast which is a medically supervised program. I had been seeing my internist since early spring 2006 being diagnosed with co-morbidities, sleep apnea, arthritis, thyroid disease, metabolic syndrome, etc... Here is the info from wellmark.com, but you need to refer to your employers benefit certificate for the final word ... they may have exclusions. Surgery for Morbid Obesity* Medical Policy: 07.01.17 Original Effective Date: September 1995 Reviewed: September 2006 Revised: September 2006 This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's benefit certificate language for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply. -------------------------------------------------------------------------------- Description: Obesity is the most frequent form of malnutrition in the developed world and it is increasing. Morbid obesity (i.e., obesity with secondary serious or debilitating progressive disease) is generally associated with a body mass index (BMI) of ≥40 kg/m² (i.e. weight/height squared). Morbid obesity has a significant impact on cardiac risk factors, incidence of diabetes, obstructive sleep apnea, debilitating arthritis of weight bearing joints, infertility, psychosocial and economic problems and various types of cancers, etc. The first treatment of morbid obesity is dietary and lifestyle changes. When conservative treatment fails, a few patients may require a surgical approach. A 1991 National Institutes of Health (NIH) Consensus Conference defined surgical candidates as those who meet the following criteria: Patient has a BMI of 40 kg/m² or greater than 35kg/m² in conjunction with severe comorbidity such as cardiopulmonary complications or severe diabetes Super obesity described as BMI >50kg/m² Failure of sustained weight loss with supervised dietary and conservative treatment over the years Motivated individual with acceptable operative risk Surgery for morbid obesity, also known as bariatric surgery is based on intestinal malabsorption and gastric reduction. Surgery is considered successful if weight loss is maintained at greater than or equal to 50% of excess body weight for more than 10 years. Several different gastric reduction and intestinal malabsorption procedures are listed below: Gastric reduction (gastric restrictive) procedures: Vertical-banded gastroplasty Adjustable gastric banding Gastric bypass (Roux-en-Y gastroenterostomy); this can be done by both open or laparoscopic approach Laparoscopic silicone gastric banding Mini-gastric bypass (laparoscopic) Malabsorptive Procedures: Biliopancreatic bypass (Scopinaro Procedure) Biliopancreatic bypass with duodenal switch Policy: Prior Approval is recommended for this service. Submit a prior approval now. The following surgical procedures for the treatment of morbid obesity may be considered medically necessary when the criteria for coverage listed below are met: Vertical-banded gastroplasty Gastric bypass (Roux-en-Y gastroenterostomy); this can be done by both open or laparoscopic approach Adjustable gastric banding (Lap-Band® procedure) for patients with a BMI less than 50kg/m² Criteria for Coverage: Patient is at least 18 years old And Patient must have a documented medical history of failure to sustain weight loss with medically supervised dietary and conservative treatment for at least three years including within two years preceding surgery. Medically supervised treatment consists of physician documentation of the assessment of the patient, what health interventions are prescribed and their on-going assessment of patient's progress toward a goal of weight loss or control of an obesity-related comorbidity. And The patient must be a motivated individual with acceptable operative risk and must be evaluated by a licensed mental health provider to determine the patient's willingness to comply with pre and postoperative treatment plans, and a strategy to ensure cooperation with follow-up must be documented. And, in addition to the general requirements above, the patient must also meet one of the following weight criteria: BMI of 40kg/m² for at least 3 years Or BMI of greater than 35kg/m² in conjunction with at least one of the following: Hypertension requiring medication for at least one year Diabetes Mellitus type 2 requiring medication for at least one year Obstructive sleep apnea, confirmed by sleep study, which does not respond to conservative treatment Documented cardiovascular disease Pulmonary hypertension of obesity Or Super obesity described as BMI greater than 50kg/m² for vertical-banded gastroplasty and open or laparoscopic gastric bypass (Roux-en-Y gastroenterostomy). The following surgical procedures for the treatment of morbid obesity are considered investigational: Adjustable gastric banding (Lap-Band® procedure) for patients with a BMI equal to or greater than 50kg/m² Mini-gastric bypass (laparoscopic) Biliopancreatic bypass with duodenal switch Laparoscopic silicone gastric banding Biliopancreatic bypass (Scopinaro Procedure) Hope this helps. Jillybean