Ugh! I'm totally crushed! (Anyone else have Empire BCBS?)

I went in for my 1st consult on 4/5. I wasn't 100% sure that RNY was for me but thought I should talk to an expert. I left the office still unsure. After much soul searching and even more agonizing, I decided that I would go ahead with RNY. I started the process by making the necessary appts. to see the Psychologist and Nutritionist, I went to my PCP and got a letter and I'm planning on support meeting this week.....I thought these were my only requirements. I got a call from my surgeons office today telling me that I need the 6 months of consecutive weigh-ins before I can be approved . I DON'T WANT TO WAIT 6 MONTHS!!!!! I WANTED TO BE ON THE LOSING SIDE BY THEN!!!! Anyway.....I needed to vent and what better place than here? Anyone else have Empire BCBS Insurance? Did you have to get the 6 months? Thanks!!! Kathy

Hi Karen, I know you are disapointed and so was I. I had blue choice and I had to go to 6 months of nutrition before surgery was set. I had a hard time dealing with the first nutritionist they had me with she was just a general nutritionist not someone who deals with bariatric patients i didnt think iam still not sure, anyway after going through nutrition I was glad that I did because it taught me a lot and it will be knowledge you will need to be sucessful in your wls journey, everything is set forth for a reason. so hang in there and relax and before you know it your 6months will have flown bye. hope this helped take care and god bless ~ Holly

Oh honey, I know it seems like a eternity, but think about how long you have struggled trying to do it on your own. Definitely call the insurance company yourself. I started this process in August of last year and my surgery is scheduled for May 21st, it has been a long haul, but I know in the end it will be well worth it. Don't let it discourage you, hang in there, I am pulling for you!

Is this a requirement made by the Surgeon or the Insurance Company? If it is the surgeons then maybe try a different surgeon. If it is the Insurance Company then you will have to comply no matter where you go. My surgeon didn't require any additional weigh in's after your initial visit. Good luck to you. Sally

I have Empire BCBS and they told me it is NOT required. Call them yourself...sometimes surgeon's office staff can make mistakes. Hugs, Karen

I had Empire BC/BS and yes, needed 6 month dietary supervision and a 5% weight loss. Fortunately for me, I already had a 6 month supervised diet so the doc put it in writing with his letter. Marie

Hi Kathy, I have Empire BCBS through the state and I did not have to wait 6 months. My whole process from start to surgery was 4 months. I went to my initial orientation on 11/21/06 and had my surgery on 4/2/07. The time goes by really fast and honestly the more weight you lose before surgery the better it is for you. Good luck, Janet

Hey Kathy... I am sorry that you are going thru a hard time with your approval process. One thing that may be a big help is if you are able to give them a list of your weight loss/gains from the past. I went back as far as I could somewhat reasonably remember (for me it was over 10 years) and listed approximations for all the diet attempts and weight gains. I don't have BCBS but it was a huge plus in my approval process. Also, call BCBS yourself. Some plans have different requirements and no matter how wonderful your surgeons office is they can't always remember everything about all the insurance plans. If you have enough co-morbidities they may approve without the 6 months. Get your ducks in a row and get on the phone !! Don't quit... Keep us posted and the best of luck ! - Terri

Kathy - Sorry you are going thru this, but this is the standard for most insurance companies. I have Aetna and they require the same, too. Hopefully your post will encourage other pre op to call their insurance companies and find out what the requirements are to have wls. Just try to stay positive, and know that in the end it will be worth it. Donna open rny mar 18 2003 282/144/140

Kathy: HI! Most of us want this surgery yesterday, myself included....I do not feel that a preop wt loss attempt is a totally bad idea, the insurance company does it to disway people, if you are diswayed they win. Life is all about our perceptions. Slowing this process down and not being impulsive is the reason I support it *I mam by no means saying you ar impulsive but many are and many are UNEDUCATED it is SCAREY!*, as well making an educated and informed decision is key to longterm success. It really takes some time to get out brains wrapped around the tremendous effort we will need to undergo for life for this to be successful. Starting now w/ this opportunity to start making those habits a part of your life vs waiting to after surgery will also go a long way to helpoing you. I hope you are able to make the reframe on the preop wt loss/6mo preop diet, and see it not as a diet/number goal solely but rather just a few steps in your million mile journey to health and long-term success; which WLS is one of the million as well *it is not the destination*! Those that have goals that are health focused and functionally focused do the best (vs. those that are scale or weight/number focused). I am such a firm believer in not allowing the scale (or hunkametal that it is) to rule or dictate ones life/thoughts/feelings any longer, I agree we want to lose wt but gaining our health and ability to function in life are far more important than any number the scale can read; otherwise if it never reads the number we think, others say, a chart suggests we fail and that is simply not true!!! Most of our lives we have set RIGID, UNREALISTIC WEIGHT LOSS GOALS for ourselves that are BOTH UNATTAINABLE and CHRONICALLY DISAPPOINTING and lead to DEVASTATION & the slippery slope of self-sabotage....So viewing the wt loss as a natural result of LIVING life in healthier ways...it is the UNDERLYING lifestyle change such as exercise, food choices, self-awareness/monitoring, avoidance of emotional eating, adherence to living self responsibly in a CONSISTENT way that is the foundation to our long-term success. These choices are what makes WLS work long-term and not be another 1 year failed diet attempt (and believe me it is for MANY!)...It is a wonderful tool to build the foundation and sadly one that has a short honeymoon period for working/helping build that foundation...a mere 6 months for many, up to a 24 mo or so period..when 'if' the foundation wasn't build w/ all the needed 'supports' of diet/exercise/lifestyle changes, coping skills etc for non-emotional eating (i.e through individual therapy, support groups) it can collapse and the WLS tool if not used properly/consistently can be defeated w/o the extra supporting structures...Like having only one wall of your basement in place before putting the house on top.. what happens? it can crumble w/ the weight of the house (your life/the worlds challenges), but if you have the 4 walls in place (food choices/planning/healthy and consistent choices, exercise, self awareness/monitoring, support); then the WLS tool can just reinforce that foundation and make the house stand strong for a long long time! If you can focus on this process giving you the opportunity to do all u can do to build this foundation now/educate yourself/prepare and not the 6mo they want as totally I believe you will find the time less of a burden and may go faster. Hope that makes sense? If I can support you in any way feel free to email anytime on your journey! [email protected] ent anytime it is disappointing but yo can turn it around to be a win for you! Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"