4jin

AmyMT, StLouisGal... thanks so much guys!!!! yes group huggggsssss And I will keep you guys in my prayers.

Kaninag, See it all depends when your paperwork was submitted. Effective 1/1/2008 they have changed their requirements. This is the new requirements if your information has been submitted on or after 1/1/2008: is 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 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; AND 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 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. Surgical repair following gastric bypass and gastric restrictive procedures is considered medically necessary when there is documentation of a surgical complication related to the original surgery, such as a fistula, obstruction, erosion, disruption/leakage of a suture/staple line. My information was submitted before 1/1/2008. For my decision they must follow the guidelines/requirements before the changes were made. The only change they made is as you stated they added a medically supervised diet. However, even if they do require it for me I have it. I placed my own self on one lost from January 2007 to July 2007 65 lbs..but gained it back from July to October 2007. At that time I decided I needed medical help for the long term not just pills and diets that make you want to scream... I am still waiting for approval...don't get me wrong...but this is the info I was given by BCBS themselves. (then again we know they can be )

ditto for BCBS

Well I have BCBS GA and my paperwork was faxed on 12/17/07..I feel like they are giving me the run around...today I called for a follow up and after being transferred numerous times I was sent to leave a voicemessage. Hopefully I will get a call back.

Ok so I call my insurance company directly yet again... got the run around and transferred and transferred and transferred and transferred...then the woman I spoke to could not find anything for me in the system...I gave her the name of the last person I spoke to...she said...i know who that is, but I don't see a record for you I said faxed on 12/17/07 I have called before and others have found it...I told her what type of surgery...Lapband...she then goes oh..that's why...hold on that type is somewhere else...transfer's me and I had to leave a voicemessage... this time couldn't even speak to anyone...what is going on...I was nice...but my patience is drying thin..... :angry:angry:mad:

I am PM you the number

Good luck to you!!!! I am in the waiting lingo.......

<p> </p> <p> </p> <p> NO FLIPPIN' WAY!!! No..... Call them back and you tell them it is nor your concern nor problem that these changes occurred. If paperwork has been misplaced it is in their best interest to locate it. It is highly confidential personal medical records part of HIPPA law-it requires them to safeguard record keeping documents. By admitting to you it has been misplaced they are violating the law. Let them know you will proceed accordingly. Give them x # of days to find the paperwork, and report this to your HR benefits coordinator ASAP. This sounds like a major problem that needs addressed immediately! oh ....I am sooo..sorry to hear that...but it is time to take a stand and show them you are not afraid and will not be taken advantage of. Now...I am not saying be mean, nasty or rude...just be polite by all means..that is the key....just be firm & passive aggressive..(so they know you will not just go away).....you should not be tossed around like a hot potatoe and you are determined to find out whose hands dropped it! in the meantime....vent ...vent..here...

StLouisGal, I was thinking that was the same reason why mine has been pending...probably for their budget purposes.... Can't help it...called again...only because on 12/28/07 the manager told me to call back on 1/2/08...I even waited...I called today 1/3/08...was told still pending to be reviewed...it has been partially reviewed but not all of it...what the crap?! "we apologize for the delay"..based on holidays...and employees taking time off....blah..blah..blah...bite me! Now call back next Monday... back to kneeling and praying...it is!!!

I choose Sp as well. for the same reason coltonwade mentioned. The food calorie tracker has lots more preset options

Try under insurance...lot's of info on different MX doctor's.

oh wow......they won't fax you a copy..?

good question aimee....I never thought of that situation as well. someone please respond!??!!

CONGRATULATIONS!!!!!!!!!!!!!!!!! I am still waiting for approval but can just the same feel the happiness and relief you must feel with that approval!!!!:clap2:

Kaninag, I have BCBS. My BMI is 43 as well. I have no co-morbidities. I actually worked on gaining weight so I could surpass their mindfoundling required BMI of 40+. (Did a bit too good at gaining ha!) The general requirements lists: A. Deemed Medically Necessary by your PCP Then Meet requirements of: 1. BMI 40+ or if BMI lower should be at least 35 with TWO co-morbidities the other requirements are the usual.... psych eval nutritionist eval ekg echo physical exam lab blood works informational seminar consultation with surgeon I have a link but it is to the BCBS of Georgia....you might want to do a google search under bcbs for your state and check under their general guidelines and requirements which is the criteria they utilize when evaluating for approval process.

bandster1007, say what banded on 10/07 and have not lost!!! What is happening? does your Doc have any input on this?

ok...So I thought it over...and yes...I agree with you guys..it is a very private matter..and I will keep it to myself. Once I am banded and down the sucess path...I plan to do as Tuono John recommended to the people I know who demonstrate to me truly that it is a cry for help I will give them and intro to the lapband world.... otherwise... doing portion control...and weight watchers.. and plan on changing the subject if they insist...I shall say..weightwatchers.com check it out!!! Is it terrible my DH doesn't know the real reason of the band?

ok...So I thought it over...and yes...I agree with you guys..it is a very private matter..and I will keep it to myself. Once I am banded and down the sucess path...I plan to do as Tuono John recommended to the people I know who demonstrate to me truly that it is a cry for help I will give them and intro to the lapband world.... otherwise... doing portion control...and weight watchers.. and plan on changing the subject if they insist...I shall say..weightwatchers.com check it out!!! Is it terrible my DH doesn't know the real reason of the band?

Congrats Joanna240... good luck....!!! Meanwhile...the rest of us...wait...patiently looking at the clock and the calendar moving...

Hi there. I go to Dr. Johnson in Johns Creek, GA or Suwanee, GA. The nutritionist they recommended charges only $50. She has her own office at Dr. Johnson's office. Let me know if you want the telephone number.

so she called me back...no news yet....apparently the cert rep handling my paperwork decided to be out for the holidays with her family........... :omg:.......no not allowed!!....just kidding!!!! Guess I will have to drag the unknown until next week!!!!... (sight)(taking deep breath)...

ok so I couldn't wait ...... I called them hey....it has been over 7 days..... So the customer rep promised to call me back....after she has her manager contact the precert rep handling paperwork to check for status response.

I came across a plateau breaking diet...let me know if anyone wants me to post it!!!

ok...who was I kiddin' I couldn't resist....I called my insurance The customer care rep promised to give me a call back.... the precert dept had a long call hold time...she said will have her manager send an email to the precert rep's manager that has my paperwork and will give me a call back by 2:00PM.... yikes....I think I just made it worst.... you better bet I will be calling back by 3PM If I don't hear from her.....:phanvan:tired in the meantime..

I have BCBS of GA. My info was submitted on 12/17/07. I called the insurance around the 19th or 20th was told they received all 15 pages. But that they take 7 to 15 business days but can take up to 30 days at the latest I should hear back by 1/24/08. I am planning to call them today again, but as I understand it is the holidays I might wait depending how desperate I feel to call or not.....