adorable

Ok, I just found on my policy that bariatric surgery IS covered...if you're "morbidly obese" which in medical standards I am lol... So then I searched until I found the Blue Cross Utilization Management Guidelines which says the following (just more of what you posted above): Medical Policy Subject: Surgery for Clinically Severe Obesity Effective Date: 09/14/2006 Last Review Date: 11/13/2006 Policy #: SURG.00024 Current Status: Reviewed Description/Scope Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. There are a variety of surgical procedures intended for the treatment of clinically severe obesity. This policy addresses those procedures. Policy Statement Medically Necessary: Gastric bypass with a Roux Y procedure up to 150 cm, laparoscopic adjustable gastric banding (the Lap-Band® System), vertical banded gastroplasty, or biliopancreatic bypass with duodenal switch as a single surgery, is considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet the following criteria: 1. BMI of 40 or greater, or BMI of 35 or greater with co-morbid conditions including, but not limited to, life threatening cardio-pulmonary problems (severe sleep apnea, Pickwickian syndrome and obesity related cardiomyopathy), severe diabetes mellitus, cardiovascular disease or hypertension. *Note: Individuals considering the laparoscopic adjustable gastric banding (Lap-Band®) procedure must meet the above minimum BMI requirement and, in addition, have a maximum BMI of less than 50. AND 2. The patient 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 3. The physician requesting authorization for the surgery must confirm the following: * The patient’s psychiatric profile is such that the patient is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and * The patient’s post-operative expectations have been addressed; and * The patient has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and * The patient has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and * The patient has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and * The patient’s treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and * The patient's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed. For revision of a gastric restrictive procedure for clinically severe obesity, there must be documentation of a failure secondary to a surgical complication such as fistula, obstruction or disruption of a suture/staple line, and is subject to the same criteria listed above. :amen: Blue Cross of California_ Medical polices and Clinical UM Gui....pdf

That is so wonderful to hear! I go for my first seminar on Tuesday and from past posts it appears that Blue Cross of CA used to give people problems with approvals. My BMI is 46 and I have comorbidities such as arthritis, hypertension, hyperlipidemia, GERD and I firmly believe I may have sleep apnea although I've never been tested for it. Hopefully this will be enough to get me approved. Any suggestions would be appreciated! Wish me luck! Denise Still researching the lapband :help: