Frustrating..

Hello All, I am so frustrated right now. I started this whole procedure June 2006 according to BCBS of Arizona/ Ameriben (biller) the requirements then was to get one medical nesscesity letter and 6 months of supervised diet. I completed my 6 month diet in December and than in January 2007 when SBC called for precertification they stated there was a change for 2007, now I have to get a 2nd letter of medical necessity and 5 years of medical history that shows diagnosis of morbid obesity. I don't even know if I've seen a doctor every year for the past 5 years (one cause due to embarrassement of my weight). So now I am try to go back and search my records to see if I have 5 years worth of documentation. Since I have only talked with PCP about this I don't know who else I can talk to about it. My PCP has already written a letter but now I need to find a 2nd one. I requested my notes from my OB/GYN and my chiropractor but I really havent developed a relationship with either one of them for them to understand my situation. Help!!

Hang on Annie! You're almost there! ......Just give every doc's name and Fax # that you have been to in the past few years and have SBC request all of your records. It shouldn't matter whether you have a personal repoire with any of them or not! .....BCBS is wanting to see your "history of obesity" as oneo f their points of proof that you need the surgery. .... BCBS has some new directives for 07 and some of them will be a bit more "pre-op friendly". Good luck! Hang in there! You're just around the corner to an amazing future! Hugggzzz, Joyce

Hi Annie, I know your fustrations... I had the same thing happen to me. When SBC called for my pre-authorization, BC/BS told them they wanted 6 months of documentation of weight loss... even though when I called and then they called they said it wasn't required. Then all of a sudden they wanted it. Fortunately, I had it and just needed to get a copy of my medical records. Definately get your medical records from ANY doctor you have seen in the past 5 years. Do you have any documentation of Weigh****chers, Jenny Craig... and or any other weight loss programs that will show your weight? I know Nutrisystem, LA Weight Loss and Jenny Craig has that stuff on file and can send you a letter (I got one from Jenny Craig). I went back all the way to my teen years with medical history and documentation. As for a 2nd Letter of Medical Necessity... I know Dr. Blackstone completes one also along with your PCP, so BC/BS wants another (3rd) one??? That is weird, but I guess common. Who are you supposed to get another one from? But, your best bet would be an OB/GYN or definately your chiropractor... I remember my old OB/GYN and Pain Specialist both got on my butt about being overweight, telling me the cause of my back pain was being overweight (thin people have back problems too!) and since he got on my case, I was going to go to him and ask for a letter, but my PCPs letter was good enough. Good Luck Annie... let me know if you need anything. Come to a support group... they are great for pre-ops and starting the process.! ~Nicole

I have BCBS Federal as my primary insurance and they denied me because of the lap band was not covered. With my original paperwork I sent everything I had. I called and got my records from LA Weight Loss and Medifast and the "diet doctor". I just told them of all the other diets that I tried. I had never spoken to my PCP regarding my weight loss until I needed the letter of medical necessity. I was never asked for any other documentation. I also have UHC through my husband and they approved me within 9 days. They said I would have to pay $800-1200 out of pocket but when BCBS added lap band on their benefits in January they resubmitted it and I got my approval letter within 6 days without any more documentation. I should not have to pay anything. Yeah!! I can save the money for plastic surgery! I have found the insurance companies were the least of my problems. There has been alot of employee turnover at Dr. Blackstones office but I think Diane is trying to do everything she can. I am an RN and I have researched the doctors in AZ and Dr. Blackstones reputation and statistics can't be beat! It has been a very long and frustrating experience--I thought that once I got the approval it would only be a matter of weeks not months but from a medical not emotional standpoint it will definitly (sp?) worth the wait! Even if you don't think that you have developed a relationship with any of you doctors--most of the time if you call for help you either get the nurse or the medical assistant helping you and they will be the ones to take the time to listen and take a personal interest in you to help you get what you need. Good luck!