MMDLynn

I can't believe after all of this BCBS denied my claim, stating that the Dr.'s 12month monitored plan was insufficient and that I needed to provide 5 years of comorbidity. My Insulin Resistance from long-term PCOS had led to the excess weight and is leading down the path to Type II Diabetes. I'm so upset right now I can't stop crying. I can't believe this is happening to me, and now my Doctor says I'll have to start all over with another physician because he's moving to Arizona to retire in September. Basically he tried, but I need to start over another full year of physician supervised weight loss diet & exercise plan. I'm so hurt - I thought this was my chance to finally improve my health. I'm 325lbs. with a BMI of 53 and Insulin Resistent on Metformin 3 x's daily to control - what else do they need? I feel like my world just came to an end!

You go girl!!!! Congrads to you!

I feel your pain - I too hate waiting. I'm awaiting approval/decision from BCBS IL for surgery. I thought it would've happened by the end of July and here were are in the middle of August. Everyday I check with the BCBS and I'm told they are still reviewing my case. God please let them approve it, so I can set a date!

:cheeky Marsha, I have PCOS and was diagnosed as Insulin Resistant 5 years ago and I've been on Metformin - prescribed by a Repro- Endo/ they seem to have a better insight for women with either PCOS or IR. Mainly because both conditions are due to hormone inadequecies which cause irregular cycles, excessive weight gain, increased glucose levels, etc. Especially if you are pre-disposed to diabetes like me (my mother had type 1 diabetes and died from complications to long term diabetes 35 years). I want to be banded as the metformin hasn't helped me one bit with the weight loss, but it has helped in reducing the side-effects/symptoms of PCOS. I've tried a variety of daily dosages 500mg once daily, twice daily, and currently three x's daily. But nothing works on the weight loss. The higher the dosage the impact worsens - upset stomach, runny stool, cramping, etc. I agree that metformin works best when Carbs are significantly reduced and Proteins are the bulk of your meals. Exercise is key as well - but nothing will beat the positive impact the band has. I'm still awaiting approval from BCBS (insurance) as I cannot afford the procedure on my own. Try switching your Protein intake and make sure that you consume 60grams daily, exercise 60 min daily 6-7 days a week, and most importantly drink your Water and lay off the carbs and the weight should come off. Most folks that are on metformin for PCOS are usually taken off the meds after banding as they glucose levels normalize. The same holds true for type II diabetics, from what I've heard. Talk with your endo about it- if you don't have one you like - get another one by all means. It's your life we're talking about. Good luck and keep us posted.

I too am a fan of Silhouette's but their clothes tend to run a size larger than they really are. However, the clothers are nice. One of my other on-line favorites is Chadwicks.com, and just my size. My all time favorite is no longer in business online. I'm not sure if they even have any stores open either...August Max Woman -they were the full-figured line for Casual Corner, great business and dressy clothing options. But, again they are no longer in business.

Mousecrazy - that's fantastic!!! You are doing so well, keep up the good work. hip, hip, hooray, hip, hip, hooray, hip, hip, hooray!!! (3 cheers)

This is a very timely subject matter. I have not told my boyfriend the details of my surgery yet. I told him that I'm probably going to have surgery soon, but not that it's WLS. I have PCOS, so he's probably assuming is in regards to that - not WLS. I will tell him once I have an official surgery date & approval from BCBS of course. But for now I want to wait. I haven't told anyone else, except my best friend D. I will have to tell my boyfriend I know, but I'm glad you brought this subject up. I agree with Vinesqueen in that honesty is always the best policy, but Kel has a good point too - details are not required, laproscopic surgery is enough detail for most men to leave at that. I think it's the females in our lives that "have to know every single detail" and being that way ourselves, we have a fear disclosing too much and being judged by others. Follow your gut - no pun intended! I'm sure all will work out just fine, and Congrads on being banded!

Chuck you I agree - you are doing a fabulous job with the weight loss - what's your secret?

Congratulations Carrie, My insurance is in the hold pattern as well, so hopefully I'll hear something this week and be able to lock in an August surgery date. I'm really happy for you...keep your fingers crossed for me please. Maybe we could be August Bandsters together!

Jane - Since you've come closer to your goal weight - have you stopped taking the metformin?

My insurance has sent a letter to lap band surgeon requesting more detailed information on the past 12months of physician monitored diet & exercise plan. Does anyone have samples of what this information looks like on paper? My physician has hired a new admin asst. and she says she doesn't know what they are looking for. Now I'm up against the wall and I have to provide the lap band surgeon with this information from June 2004-June 2005. Does anyone have samples they could share, so that I can help walk this admin asst through this process? Thanks, signed desperately seeking surgery

Thank you ladies, this really helps me a lot. Kathy I will tranfer all of my personal documentations (dates/weight, etc.) from my Jenny Craig, Nutrisystem, Weight Watchers, Adkins diet phases over the past 2 years. I'll have my doctor add them to my medical file if possible - the difficult thing is that I've changed doctors with 3 times in the past 2 years, and my current doctor is only a couple of months old. I guess I'll have to go through my OB/GYN to see if she will work with me and have this info added to my file.

I see, so you've been approved already or are you awaiting approval from the insurance company?

Thanks Rachael, that helps. I think I will have to document my journal of weight loss attempts along with my current physicians info. At least I know where to start - did they just need a date, diet & exercise plan and weigh-in for that visit?

Way to go Katerzz! You are an inspiration!!!

Thanks Alex. I'm in Chicago, so I will take your advise and stay on top of them.

For those you that had lap-band surgery covered by your insurance company - what has been your turn around timeframe, once everything was submitted by your surgeon? For example - if all documents were recieved by the insurance company today- how long did it take them insurance company approve or request additional information? I'm specifically interested in anyone that has worked with Blue Cross Blue Shield. I was told yesterday that my "preferred" surgery date of July 27th will probably not come to pass, so I'm getting a little anxious. Any and all feedback is greatly appreciated. Thanks.

Amen - Kellie you are right on point! Just look at Halle berry - she's supposed to be one of the most beautiful women in the world. Great body, beautiful face - lonely and can't keep a relationship to save her life. Plus she a type 1 diabetic, no weight issues what so ever - but is she happy? She doesn't seem to be....so be thankful, greatful and just remember to Relax... Relate.... Release!

Thanks I really appreciate the feedback. I was just wondering if the Insurance co. were to reject my request I would hear from them immediately. Or if they needed additional documentation from my PCP they would respond right away. I just hope that they approve me, I really want to get started ASAP. I feel so anxious and depressed right now. Thank God for everyone on this site! You all have no idea how much hope and inspiration you provide. Thanks.

I had my psyc eval 2 weeks ago and it was pretty non-invasive too. It was paid by my insurance, minus my co-payment. We talked about my eating habits, when I started to gain weight and what other factors contribute to my obesity, i.e. illness (I've got PCOS), predispostion ( my mother had diabetes), stuff like that. We also discussed my understanding of the banding procedure to be sure that I recognized that it's only a tool not a quick fix. We discussed how & what to eat pre & post op according to my surgeons specifications. It was a great evaluation and she told right then and there that I was an excellent candidate. Once her paperwork was received by the surgeons office - it was forwarded to my insurance co. for approval (BCBS IL - PPO). So now I sit and wait. It was painless, don't worry.

Welcome Cathy and congratulations on your band date! Hopefully I will be a July bandster too....I'm awaiting insurance approval. Welcome to the board, and read the general discussion thread and support thread. There is great information for pre & post banding. The folks at this site are in a word STUPENDOUS!!! You would be hard pressed to find a more informed or nicer group of people in one place. Good luck and welcome aboard!

Congratulations Mandy - how long did it take you to finally get approved? The reason I'm asking is that I'm in Illinois too with BCBS PPO - but my card doesn't reflect Highmark. Just BCBS PPO Of IL. My paperwork was just sent off on Monday this week and I was hoping for a July 27th surgery date, but I'm afraid it won't be processed in time.

Hi Amy - Hopefully I will be a July Bandster too (awaiting BCBS approval). Being a sister-in-arms (I'm insulin resistant due to PCOS too), are you taking Metformin or Glucophage for the PCOS and did you ask your Dr. about continuing to take these pills post surgery? I'm very curious about it, because I have a series of medications I'm taking now for PCOS (metformin), and hormone therapy (as Birth control pills didn't work)- Prometrium (pure progesterone). The prometrium is about the size of an unused pencil eraser so I wonder if it will be okay. It's a gel-filled capsule like a very small Vitamin E pill. What meds are you on currently for PCOS if you don't mind my asking. We could also talk about this one-to-one if you think it might be better. Let me know, thanks for your feedback.

Fantastic!!! Now that's the way to do it! You go Girl!!!

Welcome to Band-land. I too am awaiting surgery. You've come to the right place this is an excellent site for information, comrade-ry, encouragement, advice, and overall never ending support. If you have BCBS PPO you might not have a problem, but if you have any kind of HMO you can forget about insurance coverage. Hey you never know until you try it - if it's a PPO I say go for it, especially If you're already prepared to pay for it out of pocket. Check out the other discussion groups/threads within the site..there is a lot of information on what to expect pre & post as well as what to do and not to do for a successful banding experience. There's loads of first hand info on doctors, surgeons, fills you name it. You can do all of your research right here and go into the info session armed with specific questions, as well as share some of the things you've learned from the site. Good luck and keep on posting your updates. I'm trying to schedule my surgery for July 27th - I'm awaiting insurance approval.