Dee66

Hi. I begun my journey with my first visit to the surgeon on Jan 22. Like you, I had questions regarding the insurance company & their coverage. I called BC/BS of NJ before going and they were really informative. I was told, like you, that I needed 6 months of medically supervised weight loss plans. I was a little bummed since the last medically supervised program I was on was back in the early 1990's! While I was surfing on this site, and waiting to see if the hospital had those almost 20 year records (which they didn't), I had seen someone else was going through the same thing. One of the suggestions on this board was to just go to your PC doctor once a month, get weighed and talk about different weight loss plans. Make sure you tell your Dr that he/she need to write those notes in your chart specifically about weight loss plans. Good thing I read that little blog because I am soon going to be on month 3 of weigh in's. It was a good thing that I did that because those hospital records were never found. My surgeon's office was really helpful with this and told me that they would write down my visit with them as just an office visit so that the ins would cover the visit. I was told that even if the doctors were in my plan, they would not cover ANY appts until I was approved. I explained all this to the Psyc, Pulm, and Cardio docors. I took a chance and went to see 2 out of the 3 so far and everything has been approved. I really did take a chance and I wouldn't recommend that chance to anyone. I was just really up front and honest with the office managers in the doctors offices telling them that there could be a chance I wouldn't be covered since I wasn't approved yet and they worked the magic that they do with those codes! At least make your appts so that you have them cause it could take a while to be seen. Start by going to see your PCP and charting those weights once a month. Don't ever see anything as a set back, just keep pushing through & getting all your information. Get a notebook, keep notes and especially get names and dates of people that you speak with at the insurance company. This is a great place to come for advice because people have either gone through it or are just like you and I beginning our journey's! I hope this helps. Hang in there!

Hello everyone. I was recently watching a show on TV called Big Medicine. There was one woman who had a "Medina Band" a few years back and they needed to remove it so she could get a GBP cause she gained her weight back. First of all, was this the first type of Lap Band? Second, the ones they use now aren't like this one are they? I was just curious cause they showed the doctor holding a band and it sure looked like the one I was shown. If anyone could clarify this information I would be very appreciative! Thanks so much

Oh good. Thanks for replying. I was a little concerned when I saw that episode the other night. That show is great and I enjoy watching it every week. Too me, it helps me to understand and to see a little bit more than just with what goes on with myself. Thanks for clarifying that information with me.

Hi Paty....I have no idea when you posted but after doing a little navigating on this board, I was able to find that you went to Dr. Morris Washington as well! I just started with him the 3rd week of January and have only met with Jessica the PA. I would love to pick your brain and ask you questions...have you had the surgery? Please let me know either privately or on board. Thanks so much and I am so glad to find someone else that is in Dr. Washington's care! Take care and hope to hear from you soon. PS....my name is Denise!

HI! I was so glad to see you are from NJ....me too! I live at the Jersey Shore. I am going to a Doctor in Freehold and have only just begun my journey. Any advice, suggestions, or just to chat would be great! You can also message me privately if you want! Welcome aboard!

Hi everyone. I had my first appointment yesterday with the bariatric advisor. This was really the first step in my journey. I loved the girls at the front desk, they were so helpful and kind. The advisor was really nice too but the only thing is that I feel like I am hitting brick walls and I haven't even begun yet! She had told me that in addition to the letter of medical necessity (which I had already gotten) I needed to have 6 months of medically supervised weight loss records! This is kind of a let down since the only plans I have been on are the ones on my own (WW, Nutri-system, Jenny craig, etc.) Apparently, BC/BS has changed their policy as of jan 08 and this is what they require. I feel a little beaten down because I really thought that YEARS of documented weight loss and receipts for hundreds of dollars worth of pills and programs would have been enough. If anyone has any idea's as to how I can get around this or any suggestions PLEASE let me know. I truly appreciate it cause I am feeling a little beaten down right now. Thanks

Thanks everyone for their input. Trust me, all day today I kept hemming and hawing about pushing on. I decided that there is NO WAY some insurance company is going to knock me down with all the money I have given too them over the years! I most likely could have paid for 2 surgeries if I added it all up! I called my PC doctor and requested ALL 5 years of my charted weights! That was ALSO another thing BC/BS needed. I also took the advice of Faithmd and made an appointment for the first week in Feb. I had an appt on Jan 14 so I will go every month also. There was one really interesting thing the PA had said too me when she mentioned that BC/BS needed these weights. I had remembered today that back in the 1990's I had attended Opti Fast through a local hospital. When I called she had said to try and get the records because NO WHERE in the requirements did it state that it had to be within a certain time period. She also said that could be an argument with BC/BS. I actually read the requirements and it didn't say that it had to be recent. Now, hopefully the hospital will have these records! I will keep you all posted. Thanks:smile:

I have BC/BS direct Access. I thought this was one of the best plans that they offer but I guess they are really cracking down. The PA told me yesterday that this all started on the 1st of the year (just my luck 3 weeks later)!

Hi Everyone. First of all I want to say that I have been reading all your responses in this forum and have to say that you all seem so supportive :tt1:. I think it is great because to have support from people that have been through it is priceless. I have been thinking about banding for about a year or so. I have been on EVERY weight loss program/product and have spend THOUSANDS trying to loose the weight. I am 5'4 and weigh almost 260! I cannot seem to get control of this and it is out of control. I have an appt. with the bariatric surgeon on the 22nd, the cardiologist on the 28th, the pulomonologist on the 28th and the psychologist on Feb 4th. I just received my letter from my PCP today stating that I have hypertension, new onset diabetes and hyperlipidema and that in her opinion this surgery is the best thing for me. To all of you who have traveled this road before me, does it sound like I covered all my bases? I also have BC/BS Direct access...anyone had any dealings with that Insurance co? Any help/advice would be great...do I need to attend meetings for a certain amount of time? I want to get on with my life or shall I say begin my life and have heard so many great things about being banded. Thanks:smile: