So frustrating-all these hoops

All these hoops  the insurance companies are making me nuts.I had all of my stuff submitted almost 3 weeks ago.Today Barix left a message that BC/BS of NJ PPO now wants proof of a six month supervised diet.Why wasn't this told to me when I was told about the other hoops I had to jump through?I know Barix is not to blame,don't misunderstand me.On My 5 year weight history they can see monthly dates from my doc.I called my pc's office and told them what I need.Now I pray pray pray she'll be able to give them what they want.I f I need to do the 6 month thing over (it's been almost 2 years since I tried)I'll just die.Don't the insurers get it,I can't do this alone I need HELP hence willing to risk my life w/surgery.I guess being healthy and almost 400 lbs isn't bad enough.uuuuuggggghhhhhh

It is a shame that there can not be an across the board standard for WLS.  Between what the insurance companies want, the difference in the programs and the eating plans that the surgeons have, it is all maddening.  The pre-op stuff is the hardest thing.  If you have a good relationship with your PCP he/she should be able to do progress notes for 6 months worth of visits.  I wrote my own letter from the PCP as well as a letter to be included in with my insurance plea.  LIke you I had a high BMI. The good thing is that once all the hoops are done you can lay back and let them do their magic.  Then the real work begins... Good luck to you.  Your time on the loser's bench will be before you know it. Jeanne

Thank you Jeanne,I just feel like each & every  possible roadblock is being thrown at me  and I'm afraid I'll lose my nerve.The first time I started this journey my husband switched jobs so I woulda had to start over.I was so fearful of dying on the table I talked myself out of trying to get his new insurance to approve it.Now when he landed his "dream" job of county worker (ya know someone's gotta hold up those shovels lol)I just felt like "ok BC/BS is "normal" insurance so it won't be too tough and all of a sudden I felt very optimistic about making it through surgery.All of this red tape is so discouraging.I am praying my doc will call on Monday and say my letter is ready.

hi melinda it's a shame that Barix didn't tell you what you needed for approval --they deal with insurance companies every day and they should have known better -- even if you have to do the 6 month diet -- it's nothing --just a pain in the ass -- all you have to do is go to the dr once a month for 6 months and they have to record your weight and write that you are trying and that you talked about diet -- and if i'm not mistaken the diet has to be continuous for 6 months and it has to be within the past 2 years -- it's  just more BS that the insurance companies make a person do -- i guess they like the paperwork -- who knows -- but the time does fly by -- good luck to you :)  btw i know what it's like to be put on the 'waiting bench' while your trying so hard to be on the 'losers bench' -- i got slammed with the 6 month diet -- then i was slapped  with medical treatments for 28 weeks -- then after that and i had a surgery date, i was severely anemic which pushed my date ever further into 2006!! i was not a happy camper -- but it was out of my hands -- i was approved in June and couldn't have my surgery until november -- i was pushing that 6-month limit on when the approval would be good for -- but everything happens for a reason -- and today is a better day --i just had to wait a little longer for it :)  take care roberta

Roberta,      I give you so much credited for being able to deal with all your hold ups.I know I feel like running around screaming that this SUCKS!!!!!!!But  I know only people who've been through this can understand it.I keep telling myself I'm so close now it's gonna happen but when I read how simple so many got approved it makes me feel like it's never gonna happen for me.I guess for those of us who are not pampered  princesses all this crap just keeps making us stronger.Weaker ones would just quit I suppose.Have a good day!

Hi Jovigirl Dont give up : )  Schedule an appointment... face to face with your Primary Care doctor.  I tell you this because... often you have to be your OWN best advocate in this prep work.   It IS WORTH IT.. anyone here on the board can tell you.. and each of us has our own mini horror stories (sometimes anyway) about all the hoops to get through. Most of the time, a letter from the doctor saying that she was been supervising your diet, what diet you have been on, and on doctors letterhead will do the trick.  WHY the doctor and the personal approach works better I dunno?   I had receipts and proof that I had been on a diet for over a YEAR...but thats what worked for me? I went , saw my doctor, looked the doctor in the eye and said "Hey help me here".   The letter was done a couple days later, and it was the last linchpin.  MOST primary care physicians will do this with no problem...but OFTEN it does take a face to face... otherwise you deal with 2 receptionist, a head nurse, and a daily appointment nurse (for example) all of whom think a **note on a prescription pad faxed** should do it...  Often it WONT.  The insurance companies .... a lot of them sprang to pay for the surgery a few years ago then suddenly the floodgates OPENED...and they backtracked and came up with hasty rules.. which they have refined.   Or conditions to cover the surgery... Most of the time they include  (this is what I had to do -6 month supervised diet, supervised by your doctor. -over 100 pounds overweight (but that all depends on the PC doc, the surgeon, your bmi and other factors... height... other co morbidiites) -  a Sleep test to determine if are sleep apnea or sleep issues - a meeting with a mental health professional for clearance that you can make the decision,and are mentally able to make such a important choice... -sometimes a daily or weekly journal or weight history (I didnt have to do this ...some do) - blood tests and blood work up. - PRE surgery support group meetings, or surgeon support group meetings  -PRE surgery nutritionist meetings or support type meetings at your surgeon or nutritionist My doctor also (remember I was super morbid and over 600 pounds) made go on a liquids only diet for 30 days to shrink my liver .....for the surgery... and also I had to lose some weight prior to surgery. BE ENCOURAGED : ) You will get there. Its life changing... life giving...and DEFINITELY worth all the hoops. Also.. come here to the OH boards, read, lurk if you will.. but ask LOTS of questions...there is no such thing as a stupid question : )     Attend some support groups NOW (try the Toms River or Lakewood meetings if your close enough... a finer bunch of folks dont happen :P)... It took me three years to find a surgeon.. to convince my doctor and to get it all lined up Then the NEXT three years.. have been a blur :))) It works Dont give up :)) Hugs Timmy Ray

Timmy thanks for all of your advise.I am just so angry because after my consult I waited one month and heard nothing,then called Barix Clinic and was told the my insurance required a psych consult and 5 year weight history.So for the first month nothing was done and they apologized  but noone knew why I was not informed of this by my contact person.So I went and made sure those things were done as well as tests required by my surgeon.I completed everything by July 14th .Then after 2 weeks  and several calls I finally made actual contact w/my "contact person" and low and behold she DID have my missing psych consult that noone could find.And again more waiting.I started calling weekly both Barix and BC/BS and now they say they need this.I just wish they would have said this from the beginning. As for support groups,the ones you suggested are about 1-1 1/2 hours from my house.I'd have to go to Morristown again almost an hour away.I'm going to check Allentown Pa it's closer it's 45 minutes from me and see if they have anything.Meetings will be tough because of distance.I have 3 young kids and work so  having to travel is  not always an option.I know several people who've been through sugery and believe me I have picked their brains. Congratulations on your incredible loss.Keep up the great work

Hi Melinda, I too have BC/BS, and just had my surgery 2 weeks ago.  The process was a huge pain the butt!  I first tried to get approved in October, and at that point BC/BS came back and said I had to do the 6 month diet.  My PC sent me to a nutrionist at St. Peter's Hospital.  I saw her from Dec-June and did lose 30 lbs.  The once I submitted that, they came back with the 5 years medical history, which was a pain because I had several different primary care doctors. I also wrote my own letter detailing my weight loss history/attempts, etc.  Once everything was submitted, they got back to me within about 3 days with the great news!! I know it is frustrating.  I wish the best of luck, and hoping everything works out!!  I am sure it will!

Jenn

Jenn,thank you.Best of luck to you on the losers bench.I hope I can join you there SOON!

MeLinda -- btw that is a pretty name :)  my husband had it easy -- went to the consult -- got his testing together  -- had to do a 3 month diet (but since he goes to all my dr appts the dr just wrote a letter stating he did the diet and used my appts for him too) -- submitted paperwork -- 2 week wait for approval -- did his pre-op stuff -- surgery -- and sat home for 6 weeks -- only cuz he could sit home -- besides i was sick so it was really good to have him home :)  and that was all he had to do -- he didnt' stress -- he didn't ask questions -- he just went with the flow -- i think i got all his roadblocks along with my own!! haha  but you will see -- the final answer will be the same as everyone else on the losing side --you will have your surgery and you will lose weight and you will feel so much better physically :) that's what it's all about :)  take care roberta