Newbie - looking for friendship & guidance.

What is your BMI?  That means more to these guys than weight.  Also how much do you have to lose.  Could one of your husband go workers get the info for you so you can get a step up? 

 My DD had BCBC of MN. They only required a 3 month diet but her employers policy required 6 month so that is what she had to do.  You could have 12 people here with the same insurance and if they had 12 different employers you can come up with 12 different requirements.

If you need a diet you could start that now. Most have you do at least 3 months but, some based on bmi wave it.  That is why I asked your bmi.  I have talked to my Doc about my weight every month so I would get that out of the way while waiting for every thing else and only had to do one or two months after starting.

I would have to say with your history you will get it for sure. 

pineview01 - Thank you for your reply! My BMI right now is 49.6 and I need to lose roughly 130-140 lbs. My husband actually has been asking for information from human resources in regards to the BCBS. All we've gotten so far was a shortened version of the Explanation of Benefits, and that didn't touch on anything weight related. I am currently dieting (WW Online) and have lost about 5 lbs in the last week. Also I recently scheduled an appointment with a new doctor who will be my primary, so I will be sure to discuss my weight with her as well. I also have records from previous doctors with my weight documented throughout the years. Hopefully all of this helps. I'm trying to be as pro-active as possible beforehand. I will be attending my first seminar this coming Thursday, so I'm looking forward to learning as much as possible while I'm there.

Kari - I'm from Almont, Michigan ..... just north of Romeo.  I just had the lapband procedured done on Nov 29th, 2012, at Beauomont Royal Oak with Dr. Krause.  I also have BCBS Blue care network (PPO) through my husbands employer.  They required 6 medically supervised visits for weight loss, a BMI over 40 and/or medically necessary health issues (i.e. bp, cholestrol, diabetes).  I thought my 3 monthly visits with my PCP would count and then 3 with the Beaumont Weight Control Center (WCC)....but they did not accept the 3 visits with my PCP so I had to go three more months with the Beaumont WCC.  It was no big deal though for me as I told them at the get go that I wanted to start on the protein shakes at the beginning to help with my pre-surgery weight loss and they had me speak to a nutritionist and she gave me a diet to follow and what protein shakes to purchase so I was on two a day and two meals a day....I lost 20 lbs before my surgery date.  I'm only down about 6 lbs since the surgery, but my first fill is not until Jan 16th, 2013-----I believe that's when I will fill more restrictions!  I also attend the Beaumont WCC support groups --- they are on Thurs from 6:30pm - 7:30pm at the Beaumont Wellness Building on South Blvd west of Dequindre and just north of Beaumont Hospital Troy --- they are very informative .... there are lots that have not had the surgery yet that attend so they can get information and feed back from those that attend that have already had one procedure or another.  You might look into this as well......assuming you will have a Beaumont doctor.  Just some food for thought.....er rather protein for thought!

How has it all worked out? I also have BCBS but not BCBS of Mich. I will not touch on the insurance other then to say it will be covered to some extent by BCBS. I will not touch on the procedure or place for procedure other then to recommend my surgeon Dr. Marek Lutryzkowski of Oakland Bariatrics in Bloomfield. I will say this, you are 30 with morbid obesity and associated ills that make it especially difficult for you to lose weight. I put it off many times until I am into 40's and just recently had a Duodenal Switch. Think of how many years I wasted putting it off, then ask yourself if you want to waste many years of your life putting it off? Not only that but realistically what are the odds of you losing the weight without the Bariatric Surgery?



Couple that with quality of life issues, how good and healthy is your life now? How much better could it be /would it be with a signifigant weight loss?



Then last but not least think of the shopping possibilities, bigger clothes cost more money and have fewer options as to style etc... How much more shopping could you do buying "normal" sized clothing from swanky boutiques instead of Dress Barn or "plus size" shops?

Thank you all so much for the replies! I thought I'd give an update on what's going on. I've spent the last 2 1/2 months researching WLS and as of Jan. 1st we now have BCBS ins. I called to find out what our policy covers and they do cover the RNY (which is what I've been leaning towards). There are certain requirements, but most are waived if your BMI is 50+ (which mine is now 51...ughhh). After researching facilities I've decided I'd like to have the procedure done at Henry Ford Hospital in Detroit. (It's also a bariatric center of excellence). I'm waiting to hear from the bariatric team to see how to get this process started. But all-in-all I'm hopeful and looking forward to the possibility of a new beginning.

Glad to hear that you have the new BCBS and everything is falling into place! I know I'm going crazy just waiting!

Thanks - yes, things do seem to be falling into place so far. Are you still waiting for approval, or do you already have a date for your surgery?

I'm still in the before approval stages lol. I was approved for the program but I have to complete it before I get approved for the surgery. I have a few last forms to turn in and then they will send a request to my insurance.

Hi Keri,

At first I went to the local surgeons lecture, signed up with him, leaned toward the RNY, until I discovered the D.S., and Dr Kemmeter. I changed surgeons, and don't mind the drive to have the excellent care I have received from all the staff at Grand Health Partners.

Research all the surgeries on line, here on OH is the best place to find info. Look into them before you attend the lecture, so you will be able to ask informed questions. I know now I made the correct decision for me- the D.S. /Duodenal Switch. I have BCBS of MI. I called the customer service number on the back to see if the D.S. was covered. First I called the surgeons business office for the charge codes of the surgeries I was interested in. You dont have to be a patient to ask for these numbers. If you call Grand Health Partners, in Grand Rapids, Mi., ask for the business office, they will help you. That's my surgeons office, Dr.Kemmeter. He gives lectures too. Everyone loves his personality and compassion. Lots of us drive hours for him, even from out of state.

Many Dr's don't do the D.S., even though they may say they do, then work on changing your mind into having a surgery they can do quickly. Dr.Kemmeter does all the weight loss surgeries, he would approve your choice. Check out his web site for info about the surgeries, and patient stories. I have my story posted there. The best Dr's have achievements at the top of their fields.He is the director of Bariatrics of Saint Mary's Hospital, and Grand Health Partners is a "Center of Excellence". This is a National award, not easily obtained. They must meet many criteria to be awarded this seal of excellence. Going to a center with this insures you will have the best possible care, and surgical outcome, if it is a surgical center. These awards are given to every kind of medical category.

My main reason for choosing the D.S. was because BCBS of Mi allows only one weight loss surgery in a lifetime. I wanted to be sure I could keep off the weight, maintain my goal, less chance of regain. The D.S. is the best for this. I also wanted to eat most normal foods, eat out, not dump, "or toss my cookies". I also needed to take Advil for my arthritis. The RNY can't. I wanted the malabsorbtion factor to insure weight loss. The sleeve would be my next choice, but  more care is involved to maintain weight loss. I tried to picture what my life would be like living with each of the surgeries. I could only live with the D.S., or the sleeve. the pylorus is a must, for digestion. The D.S. and the sleeve both have it intact.

I liked Grand Health Partners support group, team approach with nutritionist trained in all the surgeries nutritional needs, behaviorist lectures, and sports physiologist to organize my work out program. They handled all my insurance needs. It was so easy. At the initial lecture I met the hospital coordinator, who answered all my questions by e-mail. I e-mailed the nutritionist and sports guy too, because I lived far from them. The on site store was so easy to pick up the foods, vitamins, supplements that are hard to find and protein mixes, when I had follow up appointments. They ship to their patients too.

I have been very pleased with my whole journey from start to finish with this Dr, and his practice. All the people are so nice, it's a warm friendly office, rare these days. They never hesitated to answer all my endless questions. I am soooo happy with my D.S. If I had to do it over, I wouldn't change a thing. I wish I had done it years ago. 

I have heard from my Dr. BCBS requires a 6 month weight loss program now. I believe it can be coordinated with your PCP, if you are coming from a distance, and can't participate in the Dr's program. Also, they have an on site psychologist for insurance requirements. Seriously, they handle it all for you. It all begins with a call to their office.

Kari - I live up north in Mio and had lap band surgery at Barix in Ypsilanti several years ago and it was unsuccessful.  I was  scheduled for RnY there on 1/4/13 but my thyroid had gotten all messed up and I had to reschedule and am currently scheduled for a band and port removal with lap RnY on 4/1 but am hoping for a cancellation date so I can get in earlier.  This is a center that does nothing but bariatric surgery and associated plastic surgery.  You might want to check it out.  Naturally, it is also a Center of Excellence.