Sandra86says

How frustrating! Im going through the same thing. Submitted for the 3rd time last week because my Medical Group wasn't "happy" with my PCPs notes for the 6th month diet. My PCP and I rewrote the notes and made them more "clear". This process has been so overwhelming. I'm so tried of waiting!! I'll say a prayer for both of us! ❤️

I have Blue Shield of Ca ( H M O )

Hello y'all! I Hope you all have a Happy Valentines Day! I have been working towards getting VSG for about a year now (partly my fault, was having 2nd thoughts). I got denied in July, for not having physician diet for 6 months... I finished the process of the 6 month diet in January, submitted and got denied again... Yep! AGAIN! This process is getting so frustrating. I'm definitely not giving up though. The reason behind my 2nd denial is that my insurance company wasn't happy with my PCPs notes. I will try to go to my surgeons office on Monday to get clear and precise information regarding the notes but I was wondering if anybody on here had any information about how their PCP wrote the notes regarding the diet... I will see him this Thursday... And resubmit for a 3rd time on Friday. Please keep in me your prayers. I have a BMI of 50 and 2 comorbidities... It's so frustrating to see many people with lower bmi's w no comorbidities get approved in 2 days (lol sorry I'm kinda bitter) I have my wedding this September so kinda anxious about that as well!! Ugh!! Thanks for allowing me to vent! ❤️

So I started this process about a year ago. Got denied in July because I didn't have my 6 month Supervised diet. Completed the 6 month last month. Submitted on 1/20 and got denied again... My coordinator will set up a Peer to Peer Review w the Surgeon and my insurance company (Blue Shield of Ca) to put an end to this madness. My question to those who ended up having a peer to peer : 1) About how long did it take to get an approval / denial? 2) How was the experience? I am so overwhelmed and frustrated at this point. I currently have 2 comorbidities and my BMI is 50! I see many people get approved so easily with a BMI way less than me and No comorbidities! I need many prayers!!

So I started this process about a year ago. Got denied in July because I didn't have my 6 month Supervised diet. Completed the 6 month last month. Submitted on 1/20 and got denied again... My coordinator will set up a Peer to Peer Review w the Surgeon and my insurance company (Blue Shield of Ca) to put an end to this madness. My question to those who ended up having a peer to peer : 1) About how long did it take to get an approval / denial? 2) How was the experience? I am so overwhelmed and frustrated at this point. I currently have 2 comorbidities and my BMI is 50! I see many people get approved so easily with a BMI way less than me and No comorbidities! I need many prayers!!

Same here! I got denied in July because i didn't have the 6 month supervised diet... Had my last weigh in a few weeks ago and now I'm patiently waiting! Seems like it's taking FOREVER!!! Hang in there girly!! Hopefully we both receive good news by this week!! ????

NO. they can't. First, there is no six months. If you're speaking of my particular situation, it depends on my BMI when I saw the surgeon or when I first saw my PCP about it (they're less than a point different) There is nothing in the selection criteria about weight lost or gained - simply weight to meet or not the BMI requirement. Thanks for always being so informative! I submitted to insurance for the 2nd time a few days ago, so I'm hoping I get good news this time around!

If you gain weight within those 6 months, will Blue Shield of California deny you? I've heard both yes and no.

Did they require 6 months of weigh ins?

THANKS SO MUCH!!! I just called my surgeons office and left a message! Like I said the sooner I get VSG the better! I really appreciate your help! ❤️ I think it's funny how I was denied on the 22nd only for Blue Shield to change the policy on the 31st! If that was the case I should've waited a week lol

HELP! ????I was denied in July for gastric sleeve. I met all the requirements (psych evaluation, BMI 49, HBP, Type 2 diabetes and PCOS) except I didn't have 6 monthly weigh ins which they required at the time. My PCP was floored! He was so upset at my insurance company for requiring the 6 monthly weigh ins, my health is in really bad shape for a 29 year old! However, I've been reading that Blue Shield of Ca just changed their requirement and that they no longer require the 6 months of weigh ins! I'm on month 3 and need advice! Should I call my surgery group and have them submit to insurance?! Has anybody had experience with this!? Thanks so much!!! The sooner I get this the better!!! ????????

Hello WLS peeps! I'm getting married on 09/24/16! Venue is booked, photographers etc...So wedding planning has commenced! On top of all that, I am halfway through my 6 month Physician Diet... I am on Month 3... SW is 265 im 5'2 I'm hoping I'll be done with the process in January, prob get approved for surgery sometime in February. ANYWHO... I was reading that wedding gowns must be ordered about 6-8 months ahead of time? I'll be about 6-7 months Post Op (down a lot of lbs hopefully) by the time of my wedding... my question is... Do they sell bridal gowns "off the rack"? Planning on getting my dress 1-2 months prior to my wedding. I am freaking out. This surgery is very important to me, got denied in July because they required 6 months which I immediately jumped on! Lol. I have no intentions of pushing the wedding back either... I understand it's going to be a stressful time but I need all the advice I can get! Planning on calling David's bridal on Monday! Anybody have experience with buying an emergency wedding gown? Thanks in advance!!

Same thing happened to me last month. They called me to tell me I got denied because of the same reason... I was so pissed off. I have to do 6 months of weigh ins...so now I'm looking to get surgery January or February of next year... I'm not as bummed anymore because I understand this will benefit me in the long run with my eating habits. Good luck!!!

So I have a dilemma... I'd like to ask my WLS community! So I'm, pre op VSG and I'm guessing I'm going to have surgery early next year (jan or feb) since I'm on month 2 of my required 6 month diet... Anywho, our goal was to have the wedding 9/26/16... I must reserve the venue exactly the year before our desired wedding date... My question is, should we keep the date or push it back another year... I don't know if I should have surgery AND have my wedding reception the same year... If I keep the date, I'll be about 6-7 months post-op. Is that too risky, dress fitting and all....?! I am really torn! I mean I don't mind pushing our wedding back another year but is it too much stress to handle having those 2 big moments in my life all in one year? What do you guys think!? I'd appreciate all your comments! Thanks yall!!!

So I got the call today.... Bad news! Insurance denied my WLS request, I need to provide 6 months of documented weight loss efforts. I told the coordinator I've been on weight watchers numerous times since 18, I'm now 29... She said insurance requires those efforts to be within the past 18 months... I'm so bummed! I've been obese since 18! Isn't that enough?! I guess I'll start to make appointments with my PCP monthly to discuss my goals... What good is that going to do? I started this journey in February, I could've done appointments then! I would've been done by next month! I just feel that I'm wasting time! Then again, who knows, I may need to come to terms with my eating habits medically, to prepare me for my surgery! Maybe it's a good thing? Just need support and advice! Has anybody been denied due to undocumented weight loss?!? What was your experience?? Thanks so much!!!

Hello! I was wondering how long you guys waited to receive authorization from your insurance company! They submitted my paperwork on July 1st... I'm getting anxious and don't wanna annoy them constantly lol... Will prob call them again tommorow if I don't hear anything by today! Thanks for replying!!!

Hey guys!!! I'm PREOP gastric sleeve patient and have done all the pre reqs so far. My last and final step before submitting to insurance is the psychological evaluation. I have an appt this Thursday! So my question is.... What will it consist of? Is there any way to "fail" an assessment? That'd be the worst! What questions will they ask? Am I overreacting? Lol any insight will help me!!! Thanks so much!!!