Recent Posts

WiseTears
on 11/22/10 4:54 am - Chicago, IL
Topic: RE: sleeve vsg has anyone had it approved?

I have BCBSIL PPO and I just found out that I got approved. I was denied twice for WLS but after submitting them 300 pages of documentation and filling a complaint with the state of Iliinois department of insurance, I was approved in 1 day. If you need assistance with anything, I'll be more than happy to help you.

    
WiseTears
on 11/22/10 4:49 am - Chicago, IL
Topic: RE: So upset with my PCP
Yes she is. The only things that you need to discuss when you walk into the office is the criteria that you need to pass to have the surgery. Actually, the next time you walk in the office, please have a sheet with your pointers (basicially what you did, diet, behavior changs, weight, bmi, life style changes, medication therapy, etc.). So, please dont tell her that you think she is trying to sabotage you. If she's anything like your first appointment, she'll just write down everything YOU discussed. YOU have to take charge of how you want the outcome. Remember this is a football game and many  are betting against you and who dont believe that WLS is neccessary. Be your own football player, coach, cheerleader and most of all BE YOUR OWN ADVOCATE!  You have the neccessary tools to get things done, so dont let others ruin your 6 months. Also, make a second appointment, but make sure its in the same month and tell her what things have changed since your first appointment. And, you dont have to submitt those notes from the first appointment.
    
Maria G.
on 11/22/10 12:35 am - VA
Topic: 12 month program
Ok..... I have Anthem BC&BC of Virginia and they require me to do 12 months of a weight management program(Weigh****chers) and do 12 months with a weight management coach(over the phone). Whats driving me crazy is that I started seeing my PCP for weight loss surgery back in July and have been monitored by her on a monthly basis. Last week was my first consultation with my surgeon and that's when my insurance is starting my 12 month program. Does anyone know if my insurance will accept the 5 months that I have ALREADY spent seeing my PCP for my weight loss? Or do I have to start from this point on?  This is so frustrating!! 
          
Maria G.
on 11/22/10 12:08 am - VA
Topic: RE: VSG or RNY?
That's funny because my situation is the exact opposite. I wanted the Sleeve because it didn't involve the rearranging of my intestine but because I am a diabetic (I want to be free from it), and also have several other health conditions, my surgeon recommended the Gastric Bypass. I on the other hand am not as torn as you.... I want what will give me the best results and if that means go with the Bypass then that's what I will do.  Ultimately the choice is up to YOU to make. Good Luck on whatever you decide.
          
yasulh
on 11/21/10 5:45 am - Augusta, GA
Topic: RE: submitt everything but....
If your insurance requires the 6-month diet, then if the surgeon submits before that is up it will be denied. Don't worry, it will go by quicker than it seems.

Tonia

RNY 11/15/2010

HW 280ish

SW (after 6 month diet) 247

Lowest post-surgery 183

Current 241

Considering revision to DS - have appointment 8/15/2017

BethR311
on 11/21/10 1:11 am - Fort Wayne, IN
Topic: RE: Aetna- pre cert vs approval? confused
The surgeon's office does it.  And congrats on the reversal!
        



    
Open yourself to possibility and possibility will present itself.
kimkel
on 11/20/10 9:50 am - Ellsworth, ME
Topic: So upset with my PCP
  I had to go for my 1st 6 month dr supervised diet this week.  The WLS Center gave me a paper that had what the insurance usually require for the dr notes.  I just got a copy of the notes yesterday.  All she did pretty much was copy down twice the criteria.  Not notes about me but about what the insurance wanted.  Not sure if that is sounded quite right.  She kept saying that it was a waste of time and money.  I was not happy when she quoted some of what I told her about the insurance requires her to only have dr notes on my supervised diet that you can't be seen for anything else. Instead of actually doing 2 different sets of notes she just wrote that I told her to do that.  She also put in there what I said about what the WLS Center said about my insurance company saying they are being sporadic about what they require for the surgery.  Why would she put those in my dr notes.  I told her I need her to put down calories, exercise, behavioral changes, weight, all my health issues, medications. ect.  I don't really know what to do about her office note because I don't think that the ins. is going to except.  Oh she also talked about when I asked her if we could use my Sept. and Oct visits to back date so we could use those. She actually wrote that in her notes for me to give to the ins. company.  Is she trying to sabotage me?  I don't know what to do. :(
XiomisMom
on 11/20/10 1:14 am
Topic: A call for help!
Hey fellow OHers!

I had RNY in August 2008. I'm pretty active on the Pregnancy after Weight loss surgery board, as I had twins five months ago. I am also a student getting a master's in counseling psychology. I'm working on my thesis right now all about obesity and weight loss surgery, which as you can imagine is close to my heart. I need some volunteers to fill out some of my forms and tell me what they think. I can send them by e-mail and you can send them back. Please PM me if you want to help me out and increase awareness of obesity, weight loss surgery (any type), the stigma we face together being obese, etc. I really want to increase the awareness of our struggles and help convince the medical/psychological community that we have a voice!

PM me and I'll send you the attachment. I really appreciate your help!

Carrie
(deactivated member)
on 11/19/10 2:15 am - east falmouth, MA
Topic: sleeve vsg has anyone had it approved?
 I have bcbs massachusetts... Husband needs to be able to take advil because he has had his knees replaced... 

We are hoping blue cross will approve the sleeve as it is the right surgery for him... but  haven't got a lot to go on... 

They were fantastic with  my RNY  so hopeful... but his pain issues are a deal breaker... 

If anyone with bcbs insurance has had some luck with the sleeve being approved we would love to hear from you... thanks
Crabadams72
on 11/19/10 1:10 am - Silver Spring, MD
Topic: RE: Changes to FEP BCBS for 2011
Thank you for the clarification.
I am new here (my first post!) and I am changing from GEHA because they require 6 months and there are more out of pocket expenses.

Hopefully the process with BCBS will go smoothly.
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