questions questions questions!

I'm about to become the number one pest on this forum but I really want to be sure I have all my ducks in a row before I start this process! (Yeah, I know, control freak much?) Those of you who have Regence BC/BS, what has the process been? Do you go to your primary care first? Do you contact Regence first? Once you're rolling, what are the steps? I know you have to have a psychological evaluation and see a dietician - about when does that happen? Who likes Legacy? Who likes OHSU? Which surgeons are great? Which, ahem, less so? Thanks to any and all who can help me. Nancy

Nancy, I have Regence BC/BS of OREGON, and they do not pay a dime toward WLS. They have an exclusion in our contract of not weight lose help. I was self paid and it sure hurt my pocket book, but it also saved my life. I just figure that I have saved for the last 20 years for this surgery. I was so tired of all the pain that I was going though daily, now I still have the back pain but not like I did, I do not have reflux anymore, which is a plus for me. I am getting better every day and prayfully will continue. I did go to my primary doctor first and he was ALL for it, I went though Dr Steven Tersigni in Coos Bay and he is just wonderful. Chrisy

Nancy - if you are a PEBB employee, Weight Loss Surgery IS covered under certain cir****tances. Check this site: http://www.or.regence.com/pebb/ and click on the Bariatric Surgery Benefit link. It will answer 95% of your questions. Linda

Nancy, I am another BC/BS patient, but my plan also did not cover WLS. I called BC/BS directly before I went to my primary care and asked them if my surgery was covered and what steps I needed to take. Even though I went the self pay option, it was worth it. One thing nice about the self pay option is that I was not restricted to the three centers of excellence in Oregon (OHSU, Legacy, and someplace in Bend). The Oregon Bariatric Center which opened last April or May in Eugene (Sacred Heart) was an excellent facility. Both surgeons, Dr. Umbach and Dr. Gorrin, as well as the entire office staff were a pleasure to work with. The only reason that OBC is not a center of excellence is that they are new to Sacred Heart and they have to wait for their application to be approved. Previously, Drs. Umbach and Gorrin had a Bariatric Center in California and have done over 1500 surgeries. The OBC website is http://www.peacehealth.org/Oregon/SHMC/BariatricCenter/BariatricCenter.htm Good Luck with whatever you choose to do. Jennifer

Nancy You will need to contact Regency BC/BS or check your handbook from them, and find out if your particular plan provides for WLS. If it does then you will need to find a center of excellance, which OHSU is one (I don't know if Legacy is.). Then you are required to attend an orientation meeting, where they explain the whole procedure. After filling out your paper work sending it in/fax it in, you will then just wait for them to contact you to set appointments. Good luck Randy

Nancy, I have Regence BC/BS and my policy does cover Bariatric Surgery as long as it is done through a Center of Excellence, which currently includes OHSU, Legacy Emanuel (both in Portland) and St. Charles in Bend. Sacred Heart in Eugene will most likely be added by late summer on early fall. When I spoke with them last November, they said it would be 9 mos to one year for them -- it is just a matter of getting a minimum number of surgeries under their belt as a facility. My first contact was to my insurer to verify my coverage and where I would need to get the service. I decided to go with OHSU. I attended an info seminar on 12/18/06 and received the info I needed and the application forms for their program. I had an appt set up with my PCP in January, so I was able to ask her to add the lab work OHSU wanted done to the list of what she was doing anyway. Also, if you are over a certain BMI, they will want you to have a sleep apnea study. You get all this info by attending the seminar -- which all the centers require. OHSU wanted results of the sleep apnea study, lab work and 2 yrs of past records from my PCP in order to set up the initial appts. I now have appts with the Nurse Practitioner, Nutritionist and Psychologist set. So, your first step is to find out about your insurance coverage and attend the informational seminar at one of the Centers that offers the surgery. I would be happy to give you any info you would like on what it has been like for me so far. I remember back in Nov/Dec when I was first starting the process I had a billion questions -- now I am down to only a million or so. Shirley

Hello Nancy, I have BCBS of Oregon,and I had to fight them for two years to get approval. I got the approval last wed., and it was because I had to hire an attorney. Our policy covers gastric bypass, and now beginning Jan.2 they also cover the lap band.During the two years of trying for approval I did everything that was required and it was determined that surgery wasn't medically necessary. I have other health issues related to obesity,and three doctors recommended surgery. But of course that wasn't good enough. I hope you will have an easier time with BCBS.

Hey Nancy, I can't say anything about BC/BS, not my insurer... but I will comment on OHSU. I know everyone's experience is different, but I loved them and Dr. O'Rourke is awesome. He's very very businesslike, but he is also extremely thorough and honest. Regarding knowing if BC/BS covers and the requirements, ask them for the SPECIFIC policy documents regarding bariatric surgery... they have them, believe me (I work in benefits) and make them give you copies. If you have any questions on the policy language or the requirements exactly mean, give me a yell Good luck! Michele