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I would call BCBS Anthem VA & ask them their requirements. Also, write down who you spoke with, last name initial, & if they have a call reference #. Also, look in your Medical Policy book. We just did a BCBS Anthem VA & the patient didn't require a 6 month doctor check. For Adults 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 (for example, 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. - See more at: http://www.bariatric-surgery-source.com/anthem-blue-cross-blue-shield-weight-loss-surgery.html#sthash.Ct5o3gCK.dpuf

The minute I made the decision to have the surgery, all of my habits went away. It was weird. I am a person that LOVES coke/pepsi & fast food. But now? I still love fast food, but I am 4 weeks out of the carbonation beverages. I been drinking unsweet tea, Water, lemonade, & juice. I find myself looking at the nutrition label & making sure it has Protein & not much sugar or 0 sugar. I sitll eat too fast, but I decided since I gave up caffeine, now I will give up fast food. Then I will make sure my portions are smaller.. I think something 'clicked' inside of my brain & I am happy that I am making better choices. I know how you feel though. Every time I made better choices, guess what? I went backwards b/c I wanted coke with the biggest burger at the fast food place. Then I would eat when I got home. My eating was out of control. In a way, it is still out of control. But I find myself telling myself out loud, NO. Whenever I want to cheat or do wrong, I just say outloud, NO. I find that is helping a lot. I think you should tell your therapist how you feel. Don't keep your feelings inside. Here if you ever need a ear. Prayers for you & your struggles.

In just 3 months, you went from a 20 to a 12? WOW. Right now, I am a size 20/22 (depends on outfit). I should have surgery in mid-Sept. I live in NC right now & none of my family can come up for my surgery so my Mother-in-Law is going to help me right now. They won't see me until Christmas/New Years. So by then, it should be noticeable that I lost weight? I didn't think that much would come off that fast. Wow. I never been below a size 18 so I might have a field day when I can finally wear small size clothing.

I want to hear YOUR favorites! Favorite Vitamins. Favorite Protein powders. Favorite recipes. Favorite meal. Favorite blender. Favorite cup/drink. Favorite plate. Favorite food scale. Favorite brands for other things that you use to help you stay on track! I am curious of everyones answers b/c I am about to start buying b/c my Doctor stated I need to start vitamins now. I been changing my eating habits slowly. I already gave up coke/pepsi drinks. I am a month out on that. I am slowly switching to non-sweetened tea. So, share your favorites! (: Thanks!

I didn't get a pre-op diet. I guess every Doctor is different. But you should get more Protein than carbs/sugars a day. Just make sure you pay attention to that more than anything. I'd say pre-op wise, you should have 50g protein & 25g sugar/carbs.

I am assuming that it isn't a covered benefit under your plan? We did a few BCBS Texas patients last month. But it was covered by their plan. Always read your policy & the underlying rules & regulations.

We did a Survey recently with a bunch of insurances & it came back that most still feel it is kinda like 'cosmetic'. Even though it's not. They think that a person can lose weight on their own & shouldn't need medicine to interfere, but yet they want you to turn to medicine to lose weight. Which makes no sense, right? Right. Also, it is ELECTIVE. Meaning, it is NOT medically necessary even though your BMI is over 40 & you have a bunch of comorbidities. You can treat your other issues with medicine, which is a lot cheaper than weight loss. But the insurance companies fail to realize, you might be able to quit half of those medicines, if you lose all the weight.. Which means? In the long run, they won't be paying for more claims. You know how some insurances want you to go through 3 - 6 months of weight loss training with a nutritionist or a weight loss doctor, well say you do what they say & lose 30lbs. But you still get denied. Why? Because you lost weight following the plan, which means, you can lose weight on your own. So why should they cover to pay the $20,000 surgery? Also, a lot of patients fail to realize, your insurance has to have it as a COVERED BENEFIT. Most people just assume that because they have insurance, they should pay. That is not the case. You should know your insurance policy like you know your social security number. You should study what they say & how they word things.. Yes, we had a few patients approved with Cigna/Samba Coverage. What is happening with your case? You can private message me if you want.

The only thing my doctor said about alcohol was that I could not have any up to 6 months after surgery. After that, I can have it, but within limits. But that is just like food. If you are not ready, then don't do it. You should be 100%. You will be supported here no matter what you do. I do think 1 meal a day is not good. I use to do that & my Doctor told me how that isn't helping me 'cause my body is storing what I ate once a day b/c it wasn't getting what it needed other times. Just be careful.

I have PCOS as well, but that has nothing to do with what you are having done. I find that mind blowing. Do you have stomach issues? I work at a hospital & I do all the pre-authorizations/benefits for bariatric procedures & we never asked for a endoscopy. I might have to pick my Doctors brain.

Is your insurance paying or are you paying? My doctors told me I didn't have to lose anything prior to surgery. So crazy how some ask you to do that & some don't. Why do you need a endoscopy?

Who is your Surgeon? I work at UNC Hospitals. I am going with Dr. Farrell. Dr Farrell is doing my surgery. I REALLY like him. He is one of the few surgeons I have ever seen that didn't treat me like some oddball because of my abdomen. Have you met with him yet? Do you have a surgery date yet? I will meet him on August 18th. But I told Lisa that I want the date of Sept 17th. Hopefully he isn't booked up on that day. Everyone states he is awesome. I work for him, but never met him.. lol. I hear some people say they like Dr. Overby, but they think Dr. Farrell is just better. I went with Dr. Farrell 'cause a coworker had it with him & she adored him.

Who is your Surgeon? I work at UNC Hospitals. I am going with Dr. Farrell.

Hello! I am in Durham, but work in Chapel Hill. How are you all?!

Thanks! I am nervous, but excited!

Depends on your Doctor. Aetna usually states they have so many days. I think it use to be 7 days from the date on the letter. If the Doctor doesn't do the peer to peer, it will be denied based on lack of documentation. You can send the clinicals, if you have them that is. If it is denied due to the doctor not doing the peer to peer, call & ask Aetna what they need from you that they didn't get from the doctors office. You can appeal your own case. You have that right. *FYI -- this is my job. I do this every. single. day. LOL. Good luck. Let me know if you have any other questions or concerns!

I am from Louisiana & did stuff for patients in Louisiana. Has any of your Doctors ever stated in any of your visits/clinicals that they are watching you because of your blood pressure? Has any told you if it doesn't go down, they will give you medicine? If so, that can help. You are technically diagnosed with it in a sense.. Just have to get a doctor to put that down into a diagnosis & into your clinicals.

I am approved. I go for my pre-op appointment on August 18th. Then one month later, I will have it. Sept 17th cannot get here fast enough! And for those wondering, I got approved in North Carolina with the State Hlth Plan at BlueCrossBlueShield. Btw: I work with insurance companies all the time with getting these types of cases approved. If anyone ever needs any or guidance, let me know! I will try to help you all. Have a great day!

I was told no to caffeine beverages, but 1 cup of coffee a day is okay. Talk to your Doctor. I still haven't had my surgery yet, but I know once I do, I will quit caffeine. I am slowly pushing it out of my life now.

Congrats!

2 years? My doctor said a year if I am happy with where I am with my weight. I think the best thing to do is to find a OBGYN that also knows some stuff about WLS. I know I read on some articles that there is a lot of OBGYN's that are also double-majoring in Bariatrics so they know what to do with patients that have WLS. If anything, get your OBGYN & WLS doctor to talk.

If they didn't see you prior to surgery, how would they know you lost weight?

Oh dear, is the pain that bad? That is my only fear.. I hear more sore than pain. Did they nto give you meds?

I am in Durham, NC! I work at UNC Hospitals & that is where I will have my surgery done at. I am very nervous, but excited!

I work at a hospital. I am in the office on Monday & Tuesday. On Wednesday, Thursday, & Friday - I work from home. When I work at the office, I am 95% at my desk, sitting. When I work from home, I am sitting on my sofa. I plan on having surgery on Sept 10th. This is my goal.. Thurs - Sept 10th - have surgery Fri - Sept 11th - go home Sat - Sept 12th - rest Sun - Sept 13th - rest Mon - Sept 14th - take off of work. Tues - Sept 15th - take off of work. Wed - Sept 16th - work at home. Thurs - Sept 17th - work at home. Fri - Sept 18th - work at home. Sat - Sept 19th - rest Sun - Sept 20th - rest Mon - Sept 21st - take off of work Tues - Sept 22nd - take off of work Wed - Sept 23rd - work at home. Thurs - Sept 24th - work at home. Fri - Sept 25th - work at home. Sat - Sept 26th - rest Sun - Sept 27th - rest Mon - Sept 28th -- go back to work. Would that be okay or no? I read so many conflicting information that I have no idea what to do. I don't wanna take off more than I have too because I am not from North Carolina & I want my days so I can go home for Christmas. (Home is Louisiana.) For those that have desk jobs, do you think this is possible or should I take the full 2 weeks off or 3? Tell me what worked for all of you, please. Thank you!

I am hoping to have surgery at the end of September. I go for my first appointment on July 13th. I work at the hospital & I do the pre-authorizations for bariatric/plastic cases so I already know what I have to do to get my insurance to pay for it. Lucky me, my hospital & my insurance have an agreement so as long as my BMI is over 40, they will cover the cost at 100%. Good luck! I am scared, nervous, & not sure. But I am tired of being overweight.