Please help me, I need some advice.

Hello, This is my 1st post here, I have been a lurker for a year or so now. I have been contemplating wls since 2000. I have been overweight all of my life and lately have been having many health problems because of it. I have tried all of the fad diets and even worked with a nutritionist in 2001. The most weight I ever lost was in 1997/8 I lost 100lbs on the atkins diet. within a year after giving up eating bacon and eggs and MEAT MEAT MEAT I decided to eat healthy again, only now my body craved things unlike anything ever before, I never ate candy, sweets or much "junk food" until then. I had a approval letter for rouxny when I first started going to a weight loss plan with geisinger in Danville, PA in 2001. I chickened out and said I could do it on my own, I have been trying it on my own ever since.......needless to say I havent been the success that I told myself I would be. I am now at my heaviest weight ever and in a battle of desperation to have the surgery. My wife is the insurance winner in this household, I am self employed but covered under her plan. It is BCBS HIGHMARK NEPA. I Am now a patient of Dr. Kaczamarski at Barix. Now to get to my point. I have been having problems getting answers form the insurance department at Barix. My inital consultation was on feb 1st 2006, About a month after my consultation I called and asked if they had heard from the ins co and they said not yet but it had been submitted and I should call back in about 2 more weeks. Shortly after I received a letter from forrest health services, a company within Barix? stating that in order to submit my info to get surgery approval I would need additional things such as 6 consectutive months of dieting with a nutritionist within 2 years of now and many other things I am having a problem getting together. Does anyone have any Ideas on how to make this process go smoother and if there is anyone that has been approved by BCBS highmark without having the diet history within the last 2 years? I really have been having a bad time and the weight has effected my joints in my legs and I have been suffering from many other ailments such as depression and high blood pressure. Please Help Thank You

Dear Frank: I don't know if I can be of help, because I am just now appealing with BCBS of IL on the same issue. I CAN tell you however, that in my appeal, I am referencing many medical studies that show that dieting does not help the morbidly obese, and both the NIH and the US Federal Government (Medicare) do not require the 6-12 consecutive month "supervised weight management attempts" within the last 24 months. Actually, both agencies have documentation that shows that this requirement is excessive. I am appealing that the 12 consecutive (in my case) months is just a tactic to delay medically necessary treatment. The Medicare decision was published on 2-21-06, and I found the link to the decision here on this board (on 2-22-06, I think). I can't find it at the moment, because I am typing this. The Medicare decision has some great examples and wording of how this requirement is excessive. Good luck! Dawn

Hi, I have some information that might help. I had to fight the diet requirement because my insurance ran out during that time and they would not cover at all. I was able to show the diet requirement was too restrictive, and I had the surgery last month. If you want to email me your mailing address, I will be happy to share what I have with you, as I have with others, because this is just a way for the insurance company to drag its feet and discourage you. Good luck!! Thanks!!