You would think they'd be running out of hoops...

Well, I have it in writing. BC/BS IL PPO requires 12 consecutive months medically supervised diet within the last 24 months in order to gain approval for gastric bypass. (new policy as of 4/9/04) I have 12 consecutive months, 5 years ago, and most recently...was not medically supervised. So...BTC tells me they will not even submit my insurance paperwork, and BC/BS says they would not approve it anyway. *Sigh* I have an appt with Dr Frantzides 9/17, but I'm not sure I should even go...I guess I have another year to look forward to before I can even be considered. Any words/thoughts of encouragement would be much appreciated.

Hang in there!! Good things come to those that wait!! I know this next year will be hard but dont give up You need a friend feel free to look me up marsha

Thanks Marsha, I really appreciate it. You and the people on this board have kept me going up to this point. I read your profiles, and consistently find inspiration. Thank you again

I'm so sorry you are going through this. BC/BS is so wierd. But I have to say, if they will pay for it, do it. What can it hurt? Maybe you will end up not even needing surgery. Wouldn't that make life so much easier. LOL Good Luck. Get an appointment with a nutritionist and get the ball rolling. We'll be waiting with you no matter how long it takes! Biscuit

Biscuit, Of course you are right. I think I'm not really that angry because I realize, on some level, I can lose weight on my own. I guess my hope with the surgery was mostly the permanence of it. I have not had trouble losing weight...my issue has always been keeping it off for any length of time. Only time will tell, and I will be here a year from now, morbidly or not. What have I got to lose is exactly right. Thank you so much for the positive thoughts, and again, I really appreciate it Hugs Anne

Hey Anne, I am sooo sorry that this is happening. I will keep you in my prayers. I really think this situation is a bunch of crap! I say submit anyway and see what happens. I would even submit to my insurance without using Fairview insurance. Good Luck...and I am praying for you. Let me know if there is anything I can do.

I don't know if these are words of encouragement or not, but I can tell you I'm in the same boat. I have BC/BS PPO through my husband's Illinois employer & they do require 12 months of medically supervised diets. But if you have severe co-morbidities, I don't know that it necessarily hurts to try again in 6 months. That's what I'm planning to do, if my hospital will submit the paperwork for me. When I first heard the requirements it completely stressed me out and, after spending the first two months biting my nails down to the quick because of it, I am now spending my time "building my case" so to speak. I have my regular bi-monthly PCP appointment, contstant endocrynology appointments, physical therapy and orthopedic appointments for my foot & my back, and appointments with a dietician (which by the way they require, but don't cover....of course!). I'm scheduled for my sleep study next week and in a few months I'm going to schedule a pschy eval. I'm basically going ahead with what I know are the prerequisites. Yeah, I may end up needing to wait the whole 12 months, but like I said, I'm going to try again in 6 and appeal the inevitable first denial based on severity of comorbidities...what does it hurt really? Not me. If they want to have their paper-pushers constantly reviewing paperwork well then let them spend their money doing that. What really kills me is that a lot of people, myself included, felt very shamed by being so obese. There were a ton of things wrong with me for a long time, but I seldom if ever sought medical attention beause I felt so humiliated by being fat and having to explain my problems (and the little dressing gown thingies don't help either!). BC/BS has saved so much damn money because of this, and I have lost quality of life because of it. Well, not any more. I've decided to go and have everything taken care of. If they want to spend their money fighting obesity surgery instead of doing what they should be doing (paying for it), well then I'm going to make sure they spend every penny of it. After all, the only way they'll eventually reduce the hoops we have to jump through is if we make it cost more for them to deny it instead of just approving it int he first place! ...getting down off my soapbox now...