kr8160311

My dr did write in my letter of necessity that I have tried weight loss programs and have failed. thanks ladies!!

Does my ins Empire BCBS pretty much say as long as the physician agrees its a go? I have all my tests done my bmi is 42.2, I have letter of medical necessity , phy eval, nusring nutritiousness, etc. The only thing I DONT have is weight records. I never been to a pcp. Is Empire BCBS not asking for this? could this be correct? Could it be that easy? Please read and give me your feedback. Thanks everyone!! I'm so annoying I know but so stressing. My paper will be submitted on the 10th after my final nursing program. forgot the link http://www.empireblu..._pw_a053317.htm

This part "The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery;" does this mean I don't have to show emprie BCBS my weight loss methods but my physician only? If that is the case I should have no issues since I don't have much but my physician knows this and is fine with it? anyone? anyone??

Thanks so much. Here is mine It looks like I dont have to send in years of records of weight loss am I reading this correct? I hope so since I dont have any. It looks pretty easy but I'm how can that be?? lol Medically Necessary: Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria: BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to: diabetes mellitus; or cardiovascular disease; or hypertension; or life threatening cardio-pulmonary problems, (e.g., severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND [*]The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND [*]The physician requesting authorization for the surgery must confirm the following: The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and The candidate's post-operative expectations have been addressed; and The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed. Medically Necessary: Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria: BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to: diabetes mellitus; or cardiovascular disease; or hypertension; or life threatening cardio-pulmonary problems, (e.g., severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND [*]The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND [*]The physician requesting authorization for the surgery must confirm the following: The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and The candidate's post-operative expectations have been addressed; and The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.

Congrats everyone!! I have empire bcbs and will be submitting my paperwork on Feb 10th as my last appt with the Dr. is on feb 9th. can I ask what was required of you . It seems empire bcbs does ask for records of last reported weight etc. Thanks and congrats everyone!!

I also have empire bcbs ppo not sure if I mentioned that.

was googling Empire BCBS and I found you all! I'm so glad I did I love this board! BCBS requirements now seem pretty easy see link below http://www.empireblue.com/medicalpolicies/policies/mp_pw_a053317.htmI I have not been on a pcp since I was 18 and my OBGYN since my last birth which was 5 years ago ( they don't have records anymore) The only thing I can provide to them is my most recent visit to my new pcp and letter of medical nessissity and a BMI of 42.1 along with other requirements phy, nut,consult, etc.. I do have a letter from my foot dr from last year stating I was 220 lbs. Anway, I know you girls are far out now at least two years and I thank you for making this process much easier now for people like me. My last appt is on the 9th and drs office said she will send out on the 10th. Do you think my lack of having years worth of pcp will hinder my approval? Looking at there requirements it does not seem they need it just as long as my pcp deems this. Thoughts? Also how is everyone doing two years out?? My husband is Union Carpenter in NY and I'm under his ins. THANK GOD!!!

So what was your exp with them? I have not been to a pcp in since I was younger so I have no previous weight to show them. I did go recently to get my letter and she felt I was a great candidate and stated that in the letter. I have my last requirement to fill on the 9th and was told that my drs office will send/fax the papers on the 10th. I'm so scared it won't get approved!! I have a bmi of 42.1 and have everything done expect previous weight proof to show them. Can anyone tell me there prior experience with them? My drs office does not see an problem at all then even gave me a date for surgery for the 21st they are not stressing like me.. Can anyone keep me there input It would help greatly! Thanks all!!

My last test is Feb 9th and my doctors office said she will mail/fax my paperwork over on the10th!! I have not been to a pcp ever! Since I was a child so the only letter I got from a pcp is the recent one stating why I need this surgery. I have a BMI of 42.1 and I'm 38. What was your turn around time with BCBS? I was able to provided everything but pcp notes of prior WL. I can't stop wondering what will happen and will be devastated if this does not get approved. My surgeons office already put me in for a Feb 21st surgery. They seem to feel it won't be an issue at all. Thanks all!

Hi everyone I have been reading faithfully for the last two weeks. I'm from NY , living in NJ now and half way through all my requirements. Tomorrow I have my pshy and then next week I have nursing and that should be it. By the 7th everything should be ready to go to Empire BCBS ( if you happen to have this ins please let me know your exp) I'm 38 and have a BMI of 42.1. I have three kids the oldest is 7. I want to do this now and not look back 10 years from now and I say I should have done this. I tried every diet under the soon and yes I would lose 20 gain 30. I honestly feel its in my genes and this is something I need to do. I'm still in shock that this may happen. I just can not picture me being thin again and healthy. Its been years, decades! I just can't see it happening. I pray it does. My ins says it will be 100% covered . I have all my letters, dr appts, etc. I'm excited yet still in denial. I can't wait for my next post to read APPROVAL!!! Thanks everyone and I"m so looking forward to joining this board!!

I also want to add every since I got my letter of nessissity about a week ago I been eating like crazy... Not sure why, but I"m so sick of it... I think I gained 5lbs a day.. Just wanted to add Thanks everyone!!