Introduction

Hi there y'all. This is my first post.I'll introduce myself and give a little history. I have been doing lots of reading and research.  I am 33, have a BMI of 56 (5'1 and 297) and several co-morbidities, worst of which is my BP. I have BCBS of MN through my husband's work. They sent me a packet of information about my benefits and coverage. They do cover WLS with a 40 > BMI, as listed the two most common ones, RYN and LB. They will also consider BD/DS with a BMI >50 and significant co-morbidities. It appears that no matter what surgery, I have to meet other requirements which seem pretty standard. A phsyc eval, nutrition counseling, Dr letter stating that WLS is reccomended and proof of being MO for at least 2 years. The big one though is having to show a documented attempt of weight loss through diet and exercise within the last 2 years for at least 6 months. After doing much research, I've found that 1 Dr at CMC does "some" of the DS surgeries now. But by in large, it looks like Dr. Spaw is the leader in the middle TN area for this type of WLS.  So I have a few questions. The first is has anyone here on the TN board had the DS? If so, how's it going, what have your results been and were you happy with that choice and why. The second  question about the 6 months of documented medically supervised diet stuff. I have had the same PCP for 10 years. I am documented from ALL my weight loss attempts, success, failures and regains, but not specifically in the last 6 months and under his care during it. So is this one of those things where a person just has to jump through the hoops or is this something people have had help from the PCP's office to send what the ins co wants?

Hi!  Welcome to the Tennessee forum!  I am one of Dr. Spaw's patients but I had the RNY.  The 6-month weight loss attempt is standard for most insurance.  Dr. Spaw's staff will give you a sheet for your PCP to fill out so that you meet the criteria requested.

Dr. Spaw is fabulous and you will certainly be in good hands.

Again, Welcome!

Freddie

Welcome to the TN boards. I don't have any advise on the DS procedure since I had the RNY. I know for my insurance, I had to do a 6 month "diet". And the requirement was I had to go into see the Dr once a month for 6 months and have my weight documented and talk to the Dr about dieting (blah,blah,blah). But that is with Cigna. I am not sure if yours insurance means you have to do that also or not. It may just mean that you have to prove that you have attempted to lose weight for 6 months straight sometime within the last 2 years. Do you go to your PCP regularly? They may accept reports from your PCP showing your weight for the last 2 years and a letter from your PCP saying that you have attempted to lose weight on your own. It doesn't hurt to try and submit it and then if they say anything,  you will have to do the 6-month required diet. Which you may want to start now just in case. Your PCP will help you but your surgeons office really gives the list of everything you need to get together and they work on that and getting it submitted to your insurance. So, you need to start with getting into the seminar and visit with the hospital/surgeon of your choice. Good luck on your path to weight loss and better health!

Just wanted to say welcome aboard! I know someone here has had BC/BS of MN. they said it was way easier to get approved then BC/BS of TN. Can't remember who but they should post. I know Doug had DS and his wife had RNY he preferred the DS, just have to see whats best for you, also I think Melissa had DS? Not much help but welcome to the board. Bob

I also have BCBS of MN and I had no trouble getting approved. My paperwork was faxed to them December 19 and I was approved January 3. I consider that pretty good when you factor in the 2 holidays during that time. I did have a BMI of 53 and several co-morbidities. My PCP had documented all of the times he and I had discussed my diet attempts. I also had my Weigh****cher weight records from my last attempt about 3 years before my surgery. Also, my PCP had put me on Meridia about 6 months before we submitted for WLS approval. That may have played a big part in my rapid approval but I'm not sure. VolsDiva is our newest DS patient. Perhaps she will chime in here to let you know more about post-op life with the DS. You really do have to choose the surgery that is the best fit for you. You will love Dr. Spaw. He is an excellent surgeon and he has a great personality too. He will be one of your biggest cheerleaders.

Just stopp'n by to say Hello, and Welcome to the Tn. Board. Hugs Barb