Tammy M

Bcbs of fl wouldn't approve any of mine, I went on my husband's Aetna for the surgery and follow ups. I don'tt have the Aetna anymore, so I will be self-pay for any additional appointm.ents. Good luck!

That really sucks. I don't have the money to self pay. If you not at a 40 BMI, most insurance comanies won't approve it.

Here is princess_n_thep

"Here is Princess_n_Thep remarks on this picture"

princess_n_thep:

THESE PICTURES ARE 12 DAYS POST OP!

Both pictures show the very minmal scars/incisions. The bruising I had was very minimal. The brown/yellow rings you see around the actual incisions is NOT bruising but is the leftover "superglue" still. I take a shower EVERY day and wash them but they are slow to come off. From what I gather, they "glue" the incisions, let that dry, then put a "coating of glue" over and around the incisions again. The scab had just fallen off on the top incision so it is a little pink, my bra had scuffed it off. The only real bruising i got was the one top of the belly button. The one that was the most sore was the longer port incision.

I am VERY happy with the size of them and the expertise in the cut! I know that I am a fast healer but I expect that I would be hard pressed to find the smaller ones in 6 months. I will just keep posting updates on this thread as I go along. I plan to take another picture at 6-8 weeks post op, another at 6 mo, then another at a year.

ENJOY MY BELLY!!!!!!!!

princess_n_thep

I would love to see your pictures, but my laptop won't let me view it.

Well, after waiting a whole week, my surgeon's office was finally open. They refaxed all the information to my insurance company.

Blue cross is now requiring certain verbage in the letter that my surgeon sent to the. Now they requiring the the surgeon to include in his letter attesting basically everything that the dietician talked to me about. This is really redundancy. The medical records lady, Pricilla said she as 4 patients that were waiting for that exact letter.

Unforunately, my surgeon doesn't come in until Friday. I'm sure he will write exactly what they're now requriing. So I feeling my better that this letter will get me approved. Hopefully I'll have good news to report soon.

Bcbs is the best imo. It sounds like your drs office didnt submit all of the paperwork. bcbs of il approved in a short amount of time.

How right you are. I spoke to my insurance company today. They received no information from my dietician about pre and post op requirements. No modification information, and no exercise plan. My dietician discussed all of this with me. WOULD YOU BELIEVE SHE SUBMITTED NOTHING?

Also my surgeon dropped the ball. They need a letter from him as to why the lap band is a medical necessity. We discussed my high blood pressure, my borderline diabetes, my arthritis, my cholesteral, and my family history. WOULD YOU BELIEVE HE SUBMITTED NOTHING?

They also want to know that I will get counceling. I see my Psychiatrist once a month. In fact he was the one who submitted the letter saying that I was mentally prepared for the surgery. I am not sure if that is enough. They may want me to receive weekly counceling, but I forgot to ask my bc/bs rep that. :angry: :angry: :angry: :angry:

I, too, have BCBS of IL and my approval went very quickly and very smoothly. I have to believe the doctor's office didnt submit things appropriately. My clinic has an exercise specialist and 2 nutritionists on staff. I had to meet with both of them and I believe it was for my benefit but also to help the approval process. Once it was submitted, I was approved on the first try in a couple weeks.

I would follow up with the clinic as they should be doing this for you and should know what the insurance is looking for. Please don't give up. Anything worth having is worth fighting for and your life and health are worth having!!

Try not to get discouraged!!

.Too late,I am already discouraged. Of course all of the crap happened over the holidays. So I won't be able to get in touch with anyone until Wednesday. The other concern I have is that my husband's company is looking into changing insurance companies. So if I plan to use bc/bs to cover this, I have to do it quickly.

Day One Health is basically on Michigan Ave in Chicago. I researched it before I chose them. I really think they dropped the ball on this. It seemed like I was kind of being bum rushed because my appointment was late on Friday and everyone wanted to be off for the for the holidays. They closed the office until after New Year's Day.

I remember two things my bc/bs rep told me was I did not have a behavior modification program. That is exactly what the dietician discussed with me. I had no exercise program. That is my point. I am injured and that's what made me gain the weight. Worker's comp will not cover anymore treatments. So I am going to court for a settlement. When I receive a letter from Traveler's Insurance saying they will not cover more treatments. I will be able to go thru bc/bs to help my back. My pain management doctor says losing weight will really help my condition. I told my dietician that. She wrote something down. If that was going to be a problem, she should have talked to me about it and encourage me to at least walk 30 minutes a day.

The other thing I "think" my bc/bs rep said they need blood tests results. Has anyone had to submit a blood test to bc/bs? If not, I misunderstood him.

Someone on this board suggested I join a gym or go to the YMCA That was an excellent suggestion. I can cancel that after surgery..

Thanks to all of you that responded to my post.

You're not whining, your frustrated and are trying to get answers. It's completely understandable.

The reason may be with your husband's employer. Not all BC/BS IL are the same or offer the same coverage. It greatly depends on what the employer agrees on, and in some cases, they even have their own exclusions to coverage.

Luckily my brother in law owns the company. He would never fight to keep me from getting the surgery.

So u told the clinic u had no plan hmm.. they submitted that u need to appeal call the clinic n ask them they kno the hoops

IM MY OWN MOTIVATION

No, I told the clinic that a formal exercise program would be difficult for me because of my worker's comp back injury. I told her my doctor said if I could lose weight, a lot of my pain will improve and I may be able to exercise. I am just going to do what Missy said and join a health club.

I would definitely appeal the denial. I really think you can win this.

Ok so he wants an exercise program post op? If I were in your shoes, I'd find the cheapest gym or YMCA near you, pay for a month, then submit it. Once you get the insurance approval you can let it lapse. Even if it costs you $50 with registration fees, it's still a heck of a lot cheaper than paying for the entire Lap Band surgery out of pocket.

Don't give up.

I'm not giving up. My life depends on this. I just don't understand why most people breeze through the approval process through bc/bs of IL PPO, and I am having a hard time. Sorry to be so whiney. I'm just afraid my husband's company may drop bc/bs soon. I need to get this surgery done asap. These holiday hours are really putting me behind. No one is working this week apparently.

U stated they do require it im a little confused tammy enlighten me please

IM MY OWN MOTIVATION

U stated they do require it im a little confused tammy enlighten me please

IM MY OWN MOTIVATION

bc/bs said they needed to know what kind of weight management program I would be on after surgery. Bc/bs could have just said that thinking I won't appeal this so they don't have to pay for it.

Idk i didnt have todo a weight program my clinic posted that on the web the beginning of this year saying bcbsil doesnt require that any more just the basic question where were u going for ur surgery ? I didnt have to do a exercise plan either all i did first day sry for no spaces on my cell. i went in filled out paper work which asked about have i tried any weight options i answered with all i tried from pills to exercise any co morb. yes

IM MY OWN MOTIVATION

I am not talking about a weight management program before surgery. Yes, all insurance companies were mandated to stop that requirement in Feb. 1, 2012

Asthma gerd weight was 278 bmi was in the 40s i then spoke with dietican she told me the run down told me to start this n that. Then came surgeon he Enlightened me on dos donts and any questions. Then since the pschy. Was on vaca i scheduled an outside apt passed that. To include vitals and hey that was that waited for my eval to come faxed to bcbsil then next thing u kno hey when u want todo your surgery I WENT WITH DAY ONE HEALTH CENTER awesome reasonable caring etc they even do free lapband contest check out website

IM MY OWN MOTIVATION

Day One Health Center is where I plan to go if approved.

Hi everyone,

I am so glad I found this site. This has already given me valuable information. I am hoping to get the lap band surgery. My BMI is 40 and I have comorbities.

All my life I've weighed 130 pounds and ran 51/2 miles a day for over 20 years. In 2009 I got a severe back injury at work. Also, I was fired about a year later because I couldn't work as hard. I've gained almost 100lbs. Worker's Comp has screwed me for three years. I have a lawyer and we will be going to court soon. I believe I will get a good size settlement. I deserve it.

I just found out bc/bs of IL denied my surgery. I am not sure it was an out and out denial. They said I didn't have documentation of a behavior modification program. Yes I do. I met with the dietician and we set goals. They wanted to know about my exercise plans. They also wanted what plan I was going to use, like Weight Watchers. I simply plan to join a lap band support group..

The one thing they didn't ask me about was any blood tests. I am going to call the insurance lady at the doctor's office in Chicago to find out why she didn't include all the information my insurance needed. She assured me at my consultation that she worked with bc/bs all of the time and knew how to submit the correct information. Either she did not do her job, or bc/bs of IL doesn't want to pay for my surgery.

Tammy M

I had bcbsil bmi was 45 three co morb. Did all requirments provided and got approved within 2wks but i did jave a glitch with them they had it on hold due to a letter inwhich they did recieve the clinic i went to said that they do that as a stall technique but nothin major bcbsil doent require a weight management the only thing they require is a psch eval surgeon approval dietican approval blood a visit try again appeal it

IM MY OWN MOTIVATION

Thanks for answering, but apparently bc/bs of IL does require a weight management. They did not even mention blood test. I have the psych eval and sent that to them. You are right, the dietician did talk to me about behavior modification. Ank how can I prove to them I will exercise?

Hello all,

First post, but unfortunately I am frustrated. I know this is the holiday season, but I am sick of bl/bs of IL PPO.

I am at a 40 BMI. I found out that they denied my claim? WTF? All I read about here is how quickly bc/bs approves surgery.

The insurance guy called and said it was denied because I have no behavior modification program. Funny, the nutritionist talked to me specifically about behavior modification. I was 130 pounds and ran 5 and a half miles a day for over 20 years, and I ate well. I got hurt at work 3 years ago and gained almost 100 pounds.

Also they bc/bs guy said I have no exercise plan. Right this second I cannot exercise because of my back and knees. As soon as I lose weight, this may give me a chance to exercise. Unnfortunately, I'll never be able to run again because of a knee replacement. I can join a gym.

The last thing the insurance guy said that I have no support plan. I am going to a lap band support group if they approve this. If I have to join Weight Watchers, I will.

My doctor's medical records person is not dumb. She should know if bc/bs required that information.

I think bc/bs just wants to deny it not to have to pay for it.

Oh my husband's company is looking at other insurance companies, so I may get approved and not have that insurance any longer. I am beyond pissed.

Do any of you think I should continue to push this with my insurance company, or is a denial a blanket denial?