New to this whole game

Hello all, I have been a lurker for awhile and now a new member. Heres my story. I am 6"3" and 370lbs. I have atnea insurance and was denied twice, do to the fact my employeer opting out of the gastric part of a plan. BUT I have a plan, my wifes insurance Blue Cross of Rhode Island will cover it, but I missed open enrollment, which was April. So here I am waiting till April 2011 to even start down the road AGAIN. If it does not work out in 2011 I will come out of pocket the 20k even if I have to sell my soul. Wish me luck.

Well bummer that you missed the open enrollment!  Use this year to get yourself prepared.  Know what the prerequisites are.  Some BCBS plans require being on a "supervised diet" from anywhere from 3 months to as much as a year so if you can find that information out ahead of time, you could go ahead and get that part started.  If your PCP is willing to help you, then you go see him/her EACH AND EVERY MONTH, don't miss one single month because if you do, they can say you skipped and make you start from that month after you missed.  When I did mine, my PCP documented my weight, then also wrote in the notes that I was continuing the exercise, too.  I wanted to make sure she had in her notes that I was attempting to exercise so they couldn't come back and say "well, there's no documentation that you were attempting to lose weight on your own by showing exercise".  My BCBS plan required a six month medically supervised diet.  April of next year will be here before you know it.  If you can do some of this pre-work now, that will for sure speed things along.  You'd hate to wait until next year, then once you got on her plan, find out you have to be on a medically supervised diet for yet another year.  That would stink!!!

Good luck and welcome to the Texas Message Board!!!

My 2 cents...make sure Doc writes in notes something about discussing what you were eating and nutrirional ideas and suggetions. Make sure he note discussion of you your eating habits and diet! I went out and weighed and told them what exercise I had done they noted it it and was denied after six moths because they said there was no discussion of my diet and nutrition and habit modification!! Now this was several years ago but better to cover all bases and yes DO start now and get ahead instead of waiting for the insurace to kick in and then jumpim=ng through hoops.
Also if you start changing your eating habits to the way you will eat after surgery( incorporate 1 new habit a month), by the time you have surgery it will all feel very natural to you and your lif will not feel so turned upside down!

Meggie

 Do you have any co-mobidities that you can get your doctor to tell Aetna that it is to your best interest that you have WLS??    If so you could appeal their decision for you to have it.   I do believe that other people have gotten their surgery that way.     That is the pitts that you missed that date to get on your wife's insurance.   Is there any way possible that you could still be added???   I think I would inquire anyway.   It won't hurt.   In the mean time get as educated as you can to what your post op life will be.   I wish you  much success and welcome to the TMB ( Texas Message Board ).


Hugs and blessings~ ~~ Vivian

I sincerely hope you dont have to self pay.. however if you do.. i all but sold my soul (some days i think i did lol).. to get the money.. but it was worth every darn penny and my only regret was that i wasnt ABLE to have surgery sooner.
Wishing you nothing but the best and definately find out what your wife's insurance requirements are now so you can get behind the 8 ball and be ready when April gets here!!!
Liz

My wife has spoke with her insurance and all they require is for it to be sugested by a MD and then its what ever the requirement are of the surgery center. She has also talked to 2 ladies in her office that had it and they confirmed. They also pay for skin removal (90%)