A little help here.

Hey all. My name is Michelle and probably unlike all of you i am a bit younger. Im 16 years old researching the steps of surgery. I have done my research as far as what kinds of surgery are available and such , but i was wondering if anyone had some advice as to what to do. My insurance is Blue Cross Blue Sheild, if any of you have this insurance and are aware of the requirments please let me know this way i can get some things covered before i even try to get approved. Im currently in the Daytona area , moving to jacksonville at the end of may. If any of you care to take the time out and let me know , and give advice i would greatly apprechiate it! Good luck to all!!! - Shell If you care just Email me : [email protected].

Hi Michelle! I just went to our bariatric weight loss support group Tuesday and the surgeon commented how BC/BS of Florida is the only insurance that is nearly impossible to work with. The have 10x as many "hoops" to jump through and they tend to deny everyone even if you jump through the hoops! But that doesn't mean it can't be done. Fold get approved and have the surgery done and covered by Blue Cross. I would get started immediately though. BC/BS will be dropping wls from their covered procedures as of 1/1/05 and there will be no chance of getting the surgery covered, short of hiring an attorney and going to court. I had a different insurance, but had to get a psychological evaluation, a nutritional evaluation, and provide documentation of 6 months of weekly weigh-ins at a supervised weight loss program. Find a surgeon in your area who does the surgery...you can research them online here. Give them a call and see what they say!

Hey Michelle, I guess it's your lucky day!!! I am having a Laparascopic RNY on 3/22/04. My doctor is Dr. Mark Lieberman in Naples at the Cleveland Clinic. I also have BC/BS of FL I have the Blue Choice PPO. I will give you the WHOLE LOWDOWN ON HOW TO DO IT THE EZ WAY!!! This is what you do.......first of all they WILL NOT cover the Lap-band (gastric banding). They will cover Lap RNY, Open RNY, Vertical Gastric Banding. I have researched for years, and the Lap RNY is the least invasive, most results, and you won't have any problem with the insurance. Your surgeon should submit for approval for you with the code 43842. But here's what BCBS will want to approve you..... 1.) Your BMI has to be 40 or above 2.) You have to show that you have been morbidly obese for atleast the last 5 years (BMI of 35 or greater) 3.) You have to document all of the diets you tried and failed at. 4.) You have to prove that you have had 6 months of a dietary supervised weight loss plan (Jenny Craig, Weigh****chers, etc.) some place that will have the documentation to back you up. That's it! Then your doctor will want a EKG, bloodwork, and for you to attend a WLS support group at least one time before your surgery. I had no problem with BCBS of FL. They were awesome, and I know many others who have the same oppinion. If you need further help or want to ask me more questions, you can email me directly at [email protected] good luck, and God Bless! Gabriella

Hi Michelle, I have BC/BS of florida and followed what my doctor asked for. They gathered all the information and made sure that I had everything that I needed. Make sure you have a doctor that will do this for you. I agree with Gabriella, all that she listed is a requirement plus a phy. evaluation. I had my surgery done in Tallahasse so if you're moving in that direction you should look for good surgeons in North Florida. Again, you do need to hurry because I understand also that this surgery will not be covered by BC/BS after 01/2005. Sometimes it takes awhile to be approved but it does happen.