OBXhappy

Wow! OutsideMatchInside. I just saw your weight loss. That is fantastic. You must feel fantastic about your success in such a short time.

I'm at exactly 40 and I have a comorbidity so I could actually lose a bit and should still be okay. Truthfully, I'd love to lose it and keep it off without the surgery. Through experience I'm pretty sure that won't happen.

I can't imaging going through 2 denials and an appeal. It's such a roller coaster. I really thought my surgery would be in March and now here I am still working at getting approved. I'm not going to give up on it. I figure this gives me time to start losing some of my weight so I'm ahead of the game.

BBweightlossjourne my apologies. I tried to read your message on my phone and somehow deleted it before I even had the chance to read it. So sorry!

I sent copies of my WW and NutriSystem records to my surgeons office. I'm really not sure what they submitted so I'm waiting to get my records and then I will know what all I need to submit. Thanks for the feedback.

Hi @@OBXhappy ! I'm so sorry to hear of your denial.. I wouldn't give up .. Especially since you were told that you some of your initial concerns wouldn't be a problem. Call your surgeons office and demand for an appeal to be submitted in your behalf and tell the office to have the paper together with supportive documents. Stay on it! This happens often ,but you will have it approved if you stick with it ! All the Best to you !Also... On the other side , to answer your question regarding successful diets, I was on Phentermine for 7 months and I lost 80lbs.. Ask your Doctor about it, and. Google it and do your research . I look forward to hearing about your progress ! Take Care ! My surgeons office has stated that the surgeon will not do a peer to peerl. I pleaded with them to no avail. I was on Phentermine in 2011 which is why my weigh in for 2012 is under the 35 bmi. I agree with KMORRI obese people tend to diet constantly. So our weight varies quite a bit. I thought about going through photo albums and trying to find some photos that I could submit that would show I've always had a weight issue. I tend to avoid the camera so do not have many photos of myself. I've heard that it has worked for some. Thank you for your thoughts!

Thank you so much for your input. I have started an appeal letter and while I wouldn't mention anything about where I feel the surgeons office misled me. I did plan to briefly list each reason I was denied and how I meet the criteria. I am waiting for my medical records to be sent to me before filing the appeal. I had thought about contacting Lindstrum at wlsappeals.com Truthfully, I think I could handle the appeal letter and if worse comes to worse in 8 months it is a new year and I would then have a 5 year history. Right? I guess it just seems important enough to hire someone who has experience in filing appeals. I know my field of expertise and insurance is just not it. You have given me a lot to think about. I will sit down and make sure I have all documents in order. I haven't given up yet.

Thank you for the suggestion. That was the one time I was at the Dr's in 2012. It was a GYN appt. I had been on a diet trying to lose weight for my daughters wedding. MY BMI is under 35 for that year. I had explained that to my surgeons office on my first visit. I'm so frustrated. I'm thinking of asking an attorney to assist with an appeal. If by any chance I win an appeal. I will use a different surgeon.

I would have had to lose 25 lbs. which I could have done. Had I known that was a requirement. I was basically told not to lose it because it would put be under the bmi requirement. So, I've written a fairly detailed list of diets I've tried. The ones that worked etc. Do I submit this to my insurance or should I send it to my surgeons office and ask them to reconsider doing a peer to peer. I do not have a history with my pcp because my pcp left on maternity leave and I have a new pcp for the past year. I've seen him twice.

Received a letter from BCBS TN stating that my surgery has been denied, the reasons are: My five year weight history does not show a presence of morbid obesity. I knew that I did not have this proof going into the process. I don't go to the doctor unless I'm seriously ill so as it happened my weight was down (Due to dieting) at the one time in the year that I was at the doctor. My surgeons office assured me that would not be an issue. I questioned this at my first visit and took paperwork in on a second visit and discussed it with the nutritionist. I also have it in writing with a PA in the office stating, "It will not be a problem." They did not receive documentation of a co-morbidity. Not sure why this would not have been submitted as I had a sleep study and was diagnosed with Sleep Apnea They did not receive documentation from attending physician that I followed a non-surgical weight loss program within 2 years of surgery. I've been on one type of diet or another for the bast 20 years. Like many obese people I didn't check in with my doctor prior to going on any of them. I did not achieve or maintain 10% of weight loss I did not know this was a requirement. My surgeons office didn't mention it, in fact they stated I wanted to be careful not to go below the 35 bmi. I had checked in with my insurance and this was not on the documentation sent to me. This member only participated for 4.5 months a minimum of 6 months participation is needed. I met with a nutritionist for 6 visits. Six months in a row. Evidently it was not submitted correctly. A person from the surgeons office (not the particular office I've went to but one of their offices) called today to say that due to the missing 5 year history the surgeon will not do a peer to peer with the insurance office. After all that is a requirement by the insurance company and their isn't anything they can do about MY insurance. To top it off I have a preop appointment with my pcp tomorrow as my pcp's office called me to set up an appointment since they were sent a date of May 5 by the surgeons office. When I asked the surgeons office about the date today she said, "Oh, we just put a date on the form for insurance purposes." I'm at a loss. Trying to decide rather I sign up for Nutri-System again, or Weight Watchers etc. I've got to do something as I got rid of all my summer "Fat" clothes when I started this process as i was determined that I would be a thinner me by summer since I started this last August. Anyone know of any wonderful diets that work.

Had the stress test today. It was a treadmill test. The PA who administered the test was very kind. She had a RNY many years ago. The test was a breeze walked on the treadmill for a bit every 3 minutes the incline and speed were increased. After 15 minutes I was told the test was over. After I sat for a minute my blood pressure was taken again. All was fine. She wasn't surprised as I don't have a family history of heart disease, I've never smoked. Basically, in good health other than being obese. I agree heidikat72 2 months was CRAZY. Especially, when you think this office has 32 locations around the Philly region. I go back for my Echo tomorrow. I called before going today to verify that there was no way I could have both tests done in one visit. I was told, "No" that insurance would not cover it. That has been my frustration. Not the fact that I had to have any of the tests done. I'd rather be safe than have complications. Sometimes I wonder if reading the forums so much has caused part of the frustration. Although, I've learned a lot from them. I read about people that know their surgery date prior to having their final clearance. I read about people who have the stress and echo on the same day, etc. etc. Obviously, each case is different . . . it just feels like a rollercoaster. Oh well, hopefully, in a few weeks I will have a date. Thank you for the kind words.

Thank you, for the words of encouragement. I've been pretty positive the whole time. I think the past couple of weeks it has really gotten to me. For some reason I am freaked out over the stress test. Perhaps, it is the whole "Stress" thing. Hopefully, by Monday it can be submitted to insurance.

I wouldn't have minded waiting the 6 months if it were truly required. Yes, the bariatric md is aware of what transpired at the cardiologist. It is a very large group of cardiologists. Apparently, they have never had this happen in the past. Just my luck. Hi, My insurance BCBS Anthem also required a six month wait period during which time I had to do all the tests you mentioned. My packet has now finally been completed and sent to the insurance company as of 3 weeks ago. I was told by my insurance specialist not to expect to hear from Anthem for 4-6 weeks. (very disappointing). Others I've met in the support groups who have BCBS NC don't have to wait for so long and do hear back faster. I liked having the 6 months to prepare myself and my family for the surgery and all the changes but now I'm ready to have the surgery. I hope you mentioned your poor experience with the cardiologist with the Bariatric md. Maybe he should rethink using that Cardiologist. Good luck and hang in there.

Very short trip. Lol.

Hello all, I'm feeling so frustrated and need some input. When I first went to a highly recommended bariatric surgeon. I was told by his insurance specialist that I needed to complete a 6 month supervised diet. As per my insurance BCBS Tennessee. I was not thrilled but figured it would give me time to complete all the steps necessary. I checked with my insurance and was sent a letter stating I had to have a form filled out that included a 5 year history but nothing about a 6 month diet. The following month when I met with the nutritionist I showed her the letter and she took it out and showed it to the insurance specialist. I was told that yes, I had to have the 6 month supervised diet. So I continued going. During the first five months I was busy with lots of tests: Colonoscopy sleep Study Mammogram ekg My cardiologist appt and blood work were scheduled for the same day as my final nutritionist appt. I went to the Cardiologist group suggested by my surgeons office. I left in tears. The cardiologist doesn't believe in WLS. His comment was, "Do you have bread in your house?" I said, yes and he stated, "There you go, I do not." Then he proceeded to tell me I should learn to eat items like chickpeas. Never did he ask me if I already eat chickpeas. Basically, fat people are fat because they eat to much of the wrong thing. He was not rude just matter of fact. In the end he stated that I needed to have a stress test and Echo test done. The first appt. available for a stress test was 2 months away. After speaking with my nutrionist about it I called the cardiologist office again and they are able to fit me in for a stress tomorrow. Apparently, my surgeons office called the cardio practice and let them know how unhappy they were with them. I asked the surgeons office if I could get on the schedule and they say not until I've been fully cleared by the cardiologist. They will not submit anything to my insurance until after they have all clearances. I was told that submitting to the insurance without clearances would cause my insurance to reject my claim. That incomplete authorizations submitted to an insurance company will put that patient on hold. Oh, and I have the stress test one day and the echo on the following day. Because insurance won't pay for them if they are on the same day. Does all of this seem a bit crazy. Btw. I am going to a surgeon that is 1 hour 45 minutes away because he came so highly recommended. So, I've taken a half day off of work for each nutrition appt. and cardio appt. The surgeons office has said they are booked through April at this point. Due to previous commitments at work I can not be off in June/July. So, I'm freaking out that It will have been an entire year from the start of this process. Oh! Did I mention that the insurance specialist at my surgeons office was fired. From what I've gathered she came across like an expert but totally got things wrong. Like my 6 month supervised diet. Sorry for the book. I'm at my wits end.

My policy states 24 weeks / 6 months. In the scope of things what is one more month.

oops! hit post twice.

I have my third NUT visit this month. Three more to go. Passed my Psych eval. sleep study has been done, diagnosed with sleep apnea. Colonoscopy is scheduled for this month. My insurance company (BCBS) sent a letter stating that bariatric surgery is a non-covered surgical procedure. However, if the medial criteria is met and you are otherwise eligible then benefits may be provided. What does this mean? I'm concerned in that I have a 39 BMI and do not have 5 years of weigh ins that are at 40 bmi or more. And the paper work from insurance asks if I've achieved 10% weight loss. I've lost nothing in my first 3 months with the NUT (I'm not impressed with the NUT). If I lose my bmi is to low.

I'm only on month three so lots of time to go. My company tends to change insurance companies a lot so who knows what will happen in December when we see our new policies. I was just curious as I have BCBST now. Thanks for replying

Did you have to do 7 months supervised before you were approved. My dr's office has not heard of the change. My paper work from BCBST states 6 months. Just curious?

This is very frustrating! I'm on month four and to find out I have to wait even longer is irritating. It feels like we have to jump through all these hoops and the insurance co. can change the rules mid game.

Have you found out if you have been approved. I'm waiting on results of a sleep study before calling for an appt. with the bariatric surgeon. I too have BCBST

Hello, I too have BCBS of Tennessee. Very curious how your approval process went.

joatsaint thank you for your feedback. The insurance company did approve of the surgeon I selected. The sleep study was last night. They told me I will not have results for two weeks. I'm guessing I can't schedule an appt. with the surgeon again until I actually have the results of the sleep study. Jan