New member in Central NJ, looking for advice...

Hi, My name is Sue. I'm almost 24 years old, and I have a BMI of 43.6. I just stumbled upon this site today while searching for information on gastric bypass surgery. I've done the research and talked to many people who have been through it, now my only goal is convincing my doctor and determining exactly which procedure is for me. I recently moved to this area, and I still have to obtain my old medical records from my previous doctor. My new doctor doesn't really know me, so convincing her to refer me to a surgeon is going to be a challenge. But, I'm going to get my old records and go in there with a plan. My appointment is on the 26th. I'm up for ANY and all suggestions about approaching this with my doctor (I'm going in for a new patient physical). Also, I have Horizon Blue Cross Blue Shield POS, and I'm curious to know if any of you have this insurance and what the results were with the insurance company. I'm anxious to get things rolling, but I'm anticipating a lot of red tape. I'm not against paying for part of the surgery, but I could never afford to pay for it alone. I would appreciate any advice or stories you'd like share. It's been inspiring reading your bios and seeing your before and after pictures. I feel like I'm ready for a BIG change in my life, and I think this will change my life forever for the better!

Hi sue. my name is debbie, and i had my surgery 7 weeks ago(down 50 lbs.), i too had horizon b/c b/s insurance, they told me that the surgery would not be covered, so i contaced an insurance rep. and found a plan that my surgeon participated with ,(that actually covered WLS) then i dropped blue cross, and bought Oxford health ins., had my surgery, and then i dropped that plan, and am now back on b/c, b/s/, . this worked out great for me, i had to only appeal it 1 time and that was over the phone, and i had my answer 5 days after the appeal, the insurance cost me $398.00 per month,(i only carried it for 4 months) but it was certainly better than paying thousands out of my pocket all at once. check w/ your surgeon to see what ins. they take. do not offer up any information to the health ins company unless they request it. Oxford wanted to make sure that 6 months prior to surgery, i had never ever discussed any kind of weight loss treatments w/ my primary care doc. so just do not give any additional information than what they ask for. if you have spoken w/ doc's about weight loss in the past, then try to have your Primary care doc,tell the surgeon and ins. company, that you have exahusted all of your options and surgery is the only solution for you. i too am in central NJ, so if you need help w/ the area and doctors, just e-mail me good luck debbie

Hi Sue, I am also in central NJ on the coast. I had lap banding 5 weeks ago and I am down 24 lbs. My friend had lap by-pass 8 wks ago and is down 48 lbs so both work, it just becomes a personal choice which surgery you decide to have. We both have horizon B/S & B/C of NJ and ALL was covered for us both. If you need more info just let me know. Good Luck.............

HI Sandy I dont live far from you. I am in Hillsboro, NJ. I also have BCBS. I was covered with NO problem at all. Last year I had Cigna and I actually got turned down. I have a BMI of 63 and totally was a cadidate for surgery. I am scheduled for surgery on April 29th..YEAH!! I had no problems with my insurance. I just had to pay the intial visit to the doctor ($250) which i am getting reimbursment for and also a surgeons fee ($3K) which i am still negotiating with the doctor. BOth amounts I should get reimbersed for but I still have to pay upfront. But it is definitely worth it to get a new life. Good luck and email me if you have any other questions [email protected]. My doctor is Dr. Andrei and he is in Livingston NJ. I am having my surgery at St. Barnabas hospital in Livingston but he also works out of St. Peters in New Brunswick. GOOD LUCK and dont give up!

Hi Sue I also have Horizon BC/BS POS and haven't had any problems w/ them.In fact,I got a call today from my surgeons' co-ordinator to tell me that the insurance company had pre-certified me for my surgery scheduled for 5/17/04...Good luck w/ your new doctor~!

Hey Dee, word to the wise keep up with BCBS I have talkedto several and they will not cover after 1/224. it may not be out yet but I have talked to at least 5 people in other sttates daying the same thing. My sisters live in Florida they are the forst to drop after 1/2004 . So you know if they get away with it other BCBS in other states will follow suite like NV hs already said the same. So if yours is before then you should be ok. good luck to you! God Bless Joyce

Dear Sue, welcome to nj..where did u move from?? I live in the Atlantic Highlands area by Sandy hook so we are almost neighbors! Anyway, I can refer you to Mary Neola she is the excurtive director of Partnership in weight control. A super nice ladt. She hold a info meeting every month at Jersey Shore Medical in Neptune nj. Real easy form old Bridge striaght down 18 south to Neptune. I thenk it is on the last Tuesday of each month. She can refer you to all the right people. She worka with my surgeon Dr Romamilli at JSMC where she hold the meeting. Also there is Dr Boaro at Monmouth Medical In Long Branch and he is a good doctor as well. but he has about a year wait. I had to go to Dr Romanilli as I work for Merdian health and Jersey shore is one of there hospitals.'The next thing you need to be aware of is BCBS in different states are not going to pay for this surgery after 1/2005 so you need to get your infor in and pick a doc . Mary could help you with that. She also writes to insurance companies ect. Her fee is $150.00 bur well worth it not to have to worry if your doing it right. I was so releaved when I found out about her. Her office sets up all the psych, diet consult ect. I think she could be of a great help to you. and no she does not pay mre to give out her number but I think she is a good lady and has multitude of resources . I go to a doctor here in Hazlet whih is not far from you he is Dr Stillwell and he wills igh the letter needed. he also has a lung doc in his office as we.. there office is open 8a-8p seven days a week it is like a walk in clinic but the doctors have been around a long time. So let me know if you want any more info I am emailing Marys info to you. God Bless and take care. But timing is of the essence with BCBS I think they are going to stop paying for the WLS after jan 2005 so if I were you I would get going asap! JOyce

Hi Sue, I just re-read your post and relized that you are under the impression that your primary Dr has to refere you.........does your insurance require a referal ?? I have horizon traditional B/S & B/C and never even talked to my primary........i just made my appointment with Dr Borao and they had me approved with a phone call !! If you do need a referal you would be suprised how many DRs really are supportive of the weight loss surgeries. It is over all health they are interested in and finally there are ways to help us live a healthy life !! I never had to document anything ! I myself called and ask before my appointment because i was afraid it wouldn't be covered but the rep said as long as it was medically necessary which generally means morbid obisity(hate that discription !! LOL ) So when the time came i just let the Dr office take care of it !! Good Luck to you !! karen-- 4/8/04 241/217/175 to start !!

Sue I hope all the ladies send their good luck to you with BC/BS. If you have the PPO like she said you fdo not need the refferal. However, Romanilli will NOT see you until you go to the meeting at JSMC and meet with Mary as she is his pre cert team and he will not see you until your file is completed with her office.! I know because I have to do the same thing. So go on the tues if you have not schudled yourself with her do so and she will automatically add you to the meeting. The you meet woth her and get all your ducks in a row. But I would get that approval from them asap because if all the othere states follow suite with Florida BCBS then they will not pay after 1/2004 and I hate to see you get stuck. If you get going now it should not be an issue . So as they say CHOP CHOP!! let me know how you make out. God Bless Joyce

hello, my name is Candice. I am 27 and I have about the same BMI. I have just started my journey into this process. I have my first appointment with Dr.Slotman on May 20, 2004. I am so happy that I am going to be able to have this surgery. I don't have any advice for you since I am new at this as well but if you need to talk feel free to email me and maybe we can discuss how things are going. Good luck to you!