Hello, this is my very first post.. I have a question for anyone that will listen. I've been considering gastric bypass for a long time and I finally have a new job with insurance and I've got to a great place in my life and I felt like now is the time. I went to a seminar and it was incredible, positive and informative. I happily started filling out my packet the next day and started to try to line up appointments.

Then I got the call about my insurance. I had no idea about the 5 year documented weight history that would be required. That is the only thing holding me back from insurance helping me with the surgery. I lost my job a few years ago which meant I lost my insurance.. when I got sick? I toughed it out and never went to a doctor. I have no records of being weighed, not from a doctor, walk in clinic, ER, etc. Literally, a $20,000 mistake. I was quoted $4000 with insurance after meeting requirements. Self pay would be $24,000.

I am absolutely crushed. I've been crying for days. I'm keeping the appointment I have next Friday with my MD, I am going to ask her if she will send a letter of Medical Necessity. I feel in the back of my mind that it won't work and they won't approve it.

Have any of you had this happen? Or had a letter of Medical Necessity work for you?

Any advice would be greatly appreciated. Thank you so much.

I realize theres a good possibility no one will know the answer but I have BCBS. My insurance requirements  with them for a revision include a psych consult, nutritionist and 3 months of a supervised diet. I have a "in" with my surgeon (he works with my husband) and am wanting to have the surgery done before the end of the year because I've met my deductible. The kicker is the 3 month diet. So here is my question. Last year I visited a doctor who tested me for everything because I was unable to lose weight with my band so I was hoping it was a chemical issue. We also did a supervised diet for 6 months. What are the chances of the insurance company accepting that even though it's a year ago?

The bariatric coordinator told me to go ahead and get the records and she'd try to submit them to see.

That is wonderful!  I'm so happy for you. 

I went to my first appointment on Wednesday.  I have to do the Psychiatrist and Diatician appointments before they turn in the paper work to the insurance.  I know what you mean about how "strict" BCBS Fed is. 

My doctor said that I should have never had the Sleeve done, because that did not help my Haital Hernia.  I have horrible Acid Reflux he says it can eventually burn through to the lungs and then it could be fatal.  I have Diabetes Type II, Hypertension and possible Sleep Apnea, waiting for my results on that.  So, I'm not sure what will rule being that my surgery was 4 years ago?  Or will they just say no because I was non compliant.  The Sleeve did not work for me. 

There was a study done about 3 months ago or so.  It was discovered that quite a few Sleevers develop a hunger for sweets, even if before surgery they did not care for sweets.  That is me! 

Thanks for sharing with me I really appreciate your input.  Best wishes to you Amanda!!! 

Mine was approved today by BCBS FEP Standard.  My surgeries will be slightly more than 4 years apart.  Band to RNY.  I already had my band removed, they approved that within 24 hours.

The guidelines are in the benefits book.  They are being VERY strict...they tried to catch me on non-compliance to the previous program, but my surgeon had enough notes to prove how involved I've been.   My insurance coordinator said that they are pouring over revision requests with a fine-tooth comb.

Okay so I know they're out there, but BCBS says 'search the national provider search', yet it comes up with just 3 doctors, all of which are in Alabama.  Now, I CAN drive over there, I'm in Villa Rica and it would be an hour drive.  But... it would be an hour drive.  If I found the surgeon over there, that'd mean I'd have to endure a 1 hr drive back from there post-surgery.  Um, that would really suck!

So I live like 45 minutes west of Atlanta.  You'd THINK that there would be a plethora of BCBS PPO providers on this side, but I'm just not having any luck.  Does anyone in/around the Atlanta area know of any providers who ARE BCBS PPO okay?

Also, to make the process go smoothly, should I have my PCP submit a request for predetermination now, before I start the 6 month diet plan?  I mean, I know the BCBS of AL requirements and I know I meet them, but does it matter if I get the predetermination request submitted before my 6 month plan or after? 

I have dealt with insurance companies before, needing approval for surgery (I've had elective breast reduction surgery 10 yrs ago, then had spinal fusion done 2 years ago after 6 years of fighting with them about my back pain).  I'm good with meeting all of their requirements.  I'm 5'4" and 230-ish lbs, putting me at the BMI range of 39-41 (depending on the day), and a life-long battle with weight loss, plus I have high cholesterol and high blood pressure.  I just want to make sure I'm doing the right steps in the right order.

Thanks in advance for any information anyone can provide. :)

- Josie