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MeFirst

Gastric Sleeve Patients
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Posts posted by MeFirst

  3. Posted

    I have BCBS Fed and was approved within a week of submission a couple months ago.

    In my experience, your BMI must be 40 or higher on your initial weigh in with surgeon. Wear heavy clothes, stuff your pockets, etc.... The 2 year weight history has to be an obese weight history (over 35 BMI). As long as you have a weight for each year for the past 2 years that is above BMI 35, you should be fine.

    I had no comorbidities, a BMI of barely 40 at first weigh in (thanks to a full bladder, keys, cellphones, jeans. Lol), and an over 35 BMI for the prior 2 years.

    Good Luck!!!

  16. Posted

    My story is fairly similar to yours. I had my band out in November 2013 due to infection. It was a miserable last few months with the band, so I had NO interest in another WLS at that time. I slowly and consistently gained my weight back over the following 2 years. Despite all the exercise and diets, it came back.

    I finally started to pursue the sleeve in November 2015 on my PCP's recommendation. I had to go through all the pre-op stuff again: psych eval, NUT visits, 3 month supervised diets.....

    Because so much time had passed, I was not considered a revision. I had to start at square 1 and complete all the requirements, including the 2 year "obese" weight history required by my insurance company.

    I was approved Feb 17, and had my sleeve March 14. No regrets!! It was worth jumping through the hoops (again).

    This probably isn't exactly what you want to hear. I'd say your first step is to call your insurance company and see if they would consider you a revision because of the "once per lifetime" clause. Good Luck!!! Hope for the best!!

  17. Posted

    My insurance was the same as yours....bases approval on BMI throughout the process (not just initial visit). My BMI when I started was just over 40 (no comorbidities), so I could not lose weight until after they submitted my packet to insurance. After that, I began the first phase of my surgeons diet. I was approved by insurance and losing weight now on my 2 week pre-op diet.

    Listen to your NUT, take in all the info and implement it a bit later :).

    I should also add, that I didn't want to gain any weight during the process either.

    It seems counter productive, and it's a shame it has to be that way, but you have to do what you have to do [emoji3]

  19. Posted

    I'm so sorry that I'm not going to be much help either. My first surgeon's appt was November 3 and first NUT class November 4. So not sure which date they used.

    However, I do believe it has to be a 90 day supervised diet (not 90 days from when you met your surgeon). But......it seems that meeting with your surgeon and getting weighed in should count. Good luck finding answers. I'm curious as well.

  20. Posted · Edited by MeFirst

    Does anyone know how much we should expect to pay out of pocket with Fed BC/BS?

    I had a $200 surgeon fee

    $175 hospital fee

    2 $40 co-pays to surgeon for appts

    $100 co-pay for EGD, X-ray, and EKG

    Plus, my program had a $300 fee for all the NUT appointments and meetings. But that's not related to insurance.

    I think the anesthesiologist bills separately, so not sure about that yet. My surgery is 3/14

  22. Posted · Edited by MeFirst

    I asked my surgeon that exact question because I didn't want to have to have another surgery later to remove my gall bladder. He ordered an abdominal ultrasound and said if there were any stones or anything that looked problematic, he would remove it during my sleeve. Turns out my gall bladder is in great shape! I guess it's staying for awhile.....I hope for forever.

    Btw, I'm scheduled for March 14 too. Woohooo

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