indi1

ok.. maybe I am really missing something here... The subject of my post was "Birth Control- Mirena?". Now tonight the subject has been changed, adding "Get Off Before My Gastric Sleeve Surgery ?"

I know I didn't do that because its not my natural tone. I thought this had happened to me before, but I just thought I was crazy. Is it just a moderator function? Maybe clarifying my subject for me?

Also noticed I don't have the option of emoticons or formatting anymore either. But that is probably different.

UGH.. would not want to have it removed yet... It was sooo painful having it put in

Favoredone-Almost there woohoo!

Congratulations- I hope everything is going well and I'm really excited for you! I am pre-op so I can't speak for the Protein powder, but understand it may be difficult.

I have just read somewhere that some surgeons require you to be off birth control and smoking weeks before and after surgery due to blood clots. Has anyone had any experience with this? I have Mirena intrauterine and wonder if I will have to have it removed. Of course I will ask the doc, but wanted to others experience.

So glad things are looking up for you. Just keep moving forward!

Hi Sleeved- Yes, I was approved, after being denied. Instead of 6 visits to the PCP, they wanted 7 to make 6 complete months. So I did one more and I am approved. Then I was looking at a date the first of the year, so I excepted I would lose the benefit of not having to pay my entire out of pocket since I was now looking at January. DH told me he would help me out with the money, so I was going to accept that as a late Christmas present. Well, I found out yesterday that now they are backed up until March. Now I am back to timing issues at work. I can only say that I am amazed at how many people are having this surgery and there is such a waiting list. Anyway, I am very happy I am approved. I am also considering looking at another surgeon that may not be so booked up. I may call about that tomorrow. I just don't know if that means I will have to resubmit to insurance or not.

And you were just congratulating me and got all this...sorry Just in a "mood". I know it sounds like I am not grateful, but I really am.

Saying prayers that you recovery fully soon

Tiffani

Yes I plan to go to a center of excellence or "Blue Distintion" center. BCBS said I didn't have to but when I contaced another surgeon who was in the network, they said they could not do it. I'm sure its better anyway or at least I hope so.

Congratulations! What a great gift

I got verbal approved from BCBSIL today and they also faxed the letter over to the surgeons office while we were on the

phone. It was after 5, so I am going to call tomorrow and start asking about dates. Hopefully they will accept the faxed copy for now while the hard copy is being mailed. I know I have a 4 hour nutritional class to take but other than that I hope I'm done.

Really excited... so glad I have a place where everyone understands my excitement.

I actually had something like this happen a couple weeks ago, but reversed somewhat. I was trying to set something up with a surgeon who was in the BCBS ppo "network". The surgeons office told me they couldn't do the surgery because they were not a "blue distinction" center. I called the insurance company and they told me that it was absolutely not true. Any surgeon could do it as long as they were in the "network". Right now, I am just trying to get the approval but I have pasted below what my insurance company states about it on their website. So, I know this doesn't help much but thought I would share.

"

BCBSIL member participation is voluntary. Members whose benefit plan includes coverage for bariatric surgery will be advised of the Blue Distinction Centers for Bariatric Surgery; however, depending upon the member's benefit design, the member may be able to choose other contracted facilities without penalty. The member must complete a medical weight management program and satisfy all other criteria in the medical policy regarding Surgery for Morbid Obesity before bariatric surgery can be considered. When using a Blue Distinction Center for Bariatric Surgery, members should confirm that the surgeon is part of the contracting network by calling Customer Service. Members will not receive in-network benefits for the services of surgeons or other providers who are not in the contracted provider network of the member's health plan."

I am very graceful that I am covered, no doubt about that. And you are correct in the reasons they prefer a blue distinction center. I'm just worried about my job and finances. And I really am grateful for the "hoops" now. As I posted a few minutes ago in anthother thread, it was confirmed yesterday that I have hemochromatosis (too much Iron in my system) and I would not have found that out if I had not gone through all this and have begun treatments. It could have been much worse it I had found out later. Thanks for the encouragement!

This is SO ironic! I have BCBS-IL and currently waiting for final approval. My request was denied on 11/29 because I only went to 6 visits to my pcp for the supervised diet program. I had to go to one more for a total of 7 visits to equal 6 months of total time. That last visit was resubmitted Wednesday and I am still waiting for them to review it again. I am curios to see when this removal of that requirement will begin. Knowing my luck it will be a soon as I get approved . I really don't know if that documentation must come from your pcp or some other weight loss program. I went with my pcp because she had experience of writing good documentation for bariatric patients. I will say this and I have said it before, every time I have called BCBS, they have given the best customer service I have ever experienced coming from a big company. I have been really impressed with that but there are still hoops to jump through and it takes time for documents to go from the pcp to the surgeon to the insurance company and its very frustrating. You just have to keep notes and follow up with folks to make sure they get documentation or send documentation. The hoops have really been a blessing in disquise for me because in the process I found out I have hemochromatosis. I am so glad I found out now and can start treatments before it was too late.

WoooooooHoooooooo!

So happy for you!

hi..

I will be using short term disability, based on the fact that a surgeon will say that I need surgery. The company is not allowed to ask why or what type. My company's policy is that I have to use one week of PTO for the first week before disability kicks in.

A new delay for me today... BCBSIL now wants 7 PCP supervised visits, not 6. So I have to have another appointment with my PCP and resubmit. Such a pain in the but! I'm right here with ya!

I think maybe I would have the approval by now, but when I called the day after submittable, they told me it had already gone to the review folks and came back as incomplete. Specifically, they only saw documentation on 3 of the 6 month supervised diet visits. The woman who took my call pulled up all 38 pages and confirmed that she did indeed see all of it. She was going to "bump" it back up to the review folks. That is where it is stuck. No movement. But the fact is that it was being reviewed as soon as it came in on day one and I think it would have been immediately approved if they hadn't "missed" that other 3 months.

So this is how obsessed I am. There is a part of me that thinks the insurance is just making all of this up and deliberately trying to delay this because if I have my surgery this year, I will not have to pay anything and they will have to pay 100 percent because I have met my out of pocket for the year. If they hold me up till next year, I will have to pay all of that and they will only have to pay 80 percent. So as you can see this has consumed me to the point I am suspicious of it all.

Congratulations! :banane58:

Feel better soon. Seems like all they have to do is walk by and they drop germs! :ack2:

jasleeve- I know how you feel. My request was sent to insurance on 11/22. I seem to be obsessed with this now. Its all I think about every day. I also call them at least every other day. ( Its kind of like weighing every day, which is not the best idea). You are fortunate to have a tentative date, my surgeon's office wont even consider a date until its approved.

Hang in there.. you are not alone!

Thanks for your encouragement!

I mentioned this yesterday in a post, but the more I think about it the more its driving me crazy. Does anyone who has BCBSIL every dealt with the surgeons office saying they cant do the surgery because they are not a blue distinction site? I was told that yesterday, but also I called BCBS to confirm myself and they say that is not true. Specifically, my policy says nothing about this requirement per the BCBSIL rep. In researching the blue distinction centers on BCBSIL website, I found the statement below with indicates its voluntary for the member. I just don't know how to get the surgeons office and BCBSIL on the same page. One thing is confirmed- the surgeon is in the network, so that is good.

"BCBSIL member participation is voluntary. Members whose benefit plan includes coverage for bariatric surgery will be advised of the Blue Distinction Centers for Bariatric Surgery; however, depending upon the member's benefit design, the member may be able to choose other contracted facilities without penalty. The member must complete a medical weight management program and satisfy all other criteria in the medical policy regarding Surgery for Morbid Obesity before bariatric surgery can be considered. When using a Blue Distinction Center for Bariatric Surgery, members should confirm that the surgeon is part of the contracting network by calling Customer Service. Members will not receive in-network benefits for the services of surgeons or other providers who are not in the contracted provider network of the member's health plan."

Yay!! Congrads!

So, the request was "bumped' back up to review to point out the missing documents that they apparently missed in the packet. My nice lady "Michele" was going to call me back when she heard they had looked at it again. Impatient of course, I called back today and apparently "Michele" has the case open and is the only one who can help me. No one else can do anything because its open with her. And, there is no way I can call BCBS and ask to speak to her directly. So, I'm kinda stuck on getting any status on this issue.

Next point of confusion. I found a reputable surgeon in my area who actually had some openings this year. They took my insurance info, etc. I told them BCBS was reviewing my request.

They call me back and say that they cannot perform the surgery because they are not a blue distinction location and BCBSIL requires this.

So when I called to check on the first issue, I asked BCBS about this and they told me that my policy and my employer specifically, do allow surgery at NON blue distinction locations (as long as they are in the network) and that the doctors office was misinformed.

I have no idea how to get the two different parties on the same page.

So I just keep plugging along...