gina0922

I have the same issue in regards to the insurance changing. I currently have BCBSNJ which is changing to Aetna Jan 1st. I have done everything BCBS requested as well as what the Dr required. All my info/test results/documentation is with the Dr's insurance coordinator now. I am worried that my current insurance will try to stall me till it runs out. I have read where that is illegal for them to do that though. I have a 47.5 bmi and more co-morbidities than I want to even think about. If I am denied it will only be due to something someone forgot to include because I have done it ALL!!! Psyche, nutritionist, cardiac clearance after Angiogram, h pylori test, blood work, gall bladder ultra sound & chest xray. I even did an extra (7 in all) months of monitored diet just so they couldn't say I didn't have enough days in. One more thing I worry about (as if there weren't enough) is that I never had a regimented exercise program. I did what I could but w/COPD walking is pretty difficult at this weight. I do use my hand weights and my resistance band. Much of the exercise is in a chair. But it's moving. I can't afford a gym membership. I read Aetna required a supervised exercise program. Is that true? What's more is I don't even know if my employer chose to include or exclude wls in the new policy. They had it worded as "Medically Necessary" in the current one. Hopefully they have carried that over. If you have any suggestions or information, I would really appreciate it!

bumping this post...hoping to get an answer from someone

I am soooo nervous! My insurance is changing from BCBSNJ to Aetna Jan 1st. and who knows if it will be included or an exclusion in the new policy. I get the results from my cardiac clearance on Monday. Then everything that has not been submitted to the surgeon will be hopefully by the end of next week. Anyone know how long it takes the surgeons office to submit to the insurance? What is the "dictation" portion I have read about?

Is she insane? :thumbup: Is she even hinting to you that you should stop taking your BP med? The reason for the surgery to to eliminate the need for the BP meds due to weight loss that comes from the surgery. That is like saying well you need to have a comorbidity like type 2 diabetes to be approved for surgery but if the med's your taking for the diabetes is controlling it, then you won't be approved because of the med's or insulin, you have normal blood sugar readings. What the hell is she talking about?? You really need to speak to the surgeon about that. She could cause someone some serious medical problems if they were to stop taking a needed prescription. :thumbup:

I didn't think I stopped breathing either. Not until my sleep test. I thought I was sleeping soundly. I found out when I went to my PCP for my next monthly weigh in that my results showed that I had right at 50 events an hour. :smile2: So you really never know till you take the sleep test. But I have to say that since I have started using the CPAP machine, it has made a world of difference in how I feel during my waking hours. I'm not falling asleep at work now or even when I stop at a red light! :tt2:

It's was a breeze for me! My psych required 4 visits over 4 weeks. They mainly consisted of her asking me a lot of questions regarding my life from as early as I can remember to present. What were my reasons for having the surgery. What type of support structure did I have in place after the surgery...blah...blah...blah. I answered honestly and it was all easy. I actually liked my sessions with her and may go ahead and keep going maybe once a month. My insurance pays for 20 visits a year. You'll be fine. Just be honest...they are trained to know when you are BS'ing them. Remember, they take notes and you may forget what you told them and if you lie they can catch you and may not approve you. I wouldn't want to take that chance.

CONGRATS!!!!!!!!! Sept 22 is my birthday! I will give you my birthday wish :biggrin: Wish for anything you like! LOL

Jetti, I am right there with you about getting it all done before seeing the surgeon. I will have my last psych appt on 09/02 and the last weigh in at the dr for my 6 month diet on 09/08. My appt w/the wls is on 08/29. I wanted to be completely done but the next appt available was around the third week in September and I didn't want to wait that long. I will take my results from my mamogram, sleep apnea test, pulminologist, gall bladder ultrasound and referral from my pcp with me and just send the rest when it's done and ready. I am so ready to get approved and get my surgery date!

Hi, my doctor wants me to stay on the 6 mo diet one more month because I actually gained weight (8 lbs) and although we discussed weight loss, she did not put in her notes (in my file) that we discussed WLS in March but did in April. Will this matter? I had my 1st consultation about weight loss with her in March. I have gone each month. I am like you in that I have had 6 documented of monthly weigh ins (03/07, 04/09, 05/07, 06/09, 07/09, 08/08). If we add one more month and show the start date of 04/09 and then weigh again 09/08 will I have to wait till Oct for it to be considered a 6 month supervised diet? I just don't want to have to go through an appeal process because of 1 extra weigh in. I have BCBS and they didn't require a 5 yr history.

From what I have read, the standard rule of the whole 6 mo Dr supervised diet thing has been for the most part, ongoing monthly Dr appointments where you see the Dr, get weighed in and talk about how your weight loss is going. My Dr just had me follow a reduced calorie diet. My insurance which is BCBS of NJ just stated I had to lose or maintain my weight during the 6 months. Doesn't matter if you talk about other things, heck, your at the dr's office, it would be silly not to talk about your bad back at the same time. But you have an individual policy so I'm not sure how they would rule on that. Best of luck to you!

Ahem...well, many of you are talking about being able to be on top again. I am looking forward to just having sex again. Because of my weight and subsequent lack of self esteem I have not had sex with my husband going on on 2 years. Luckily, God blessed me with a totally loving and understanding husband. I assume he is taking care of business himself. I am sure that he would not care but I cant stand the thought of it at my weight. It affects my breathing to have all the weight pushed down on me (hubby isn't exactly a small guy) as I have breathing problems (COPD). Knees are shot so I can't do it doggy style. Can't get on top and fold my legs under me like I am sitting on the fronts of my legs because of all the swelling in my lower legs. So you can see that I am really looking forward to having the surgery. I don't care what position it is as long as I get some!!!!!

Ok, I finally called my insurance comp, BCBSNJ and was told it was "excluded unless it was medically necessary". She told me I needed a predetermination letter by my PCP. I have a 48.1 BMI with several comorbidities including Type 2 Diabetes. The medically necessary part is definitely there. What worries me is the "excluded unless it was medically necessary" part. I have read all around my insurance book. I didn't see anything about WLS. Even in the exclusions section. Has anyone come across this situation or verbiage in your insurance book? If so, were you approved? Thanks, Gina

I have BCBSNJ too but I live in FL. What did they require of you to approve you for the WLS? Congratulations!! Gina

I see the Dr tomorrow which will be the end of my 3rd month. I really will be glad when it's over and done though! Gina

Hi, does anyone have a good example of a predetermination letter that I can use that would cover either the LapBand or the RNY bypass? I go to the Dr on Wed as part of my 6 mo Dr supervised program and I would like to go ahead and have her fill out one so I can submit it to my ins. I have to find out what is covered if anything before I go any further. I am an emotional wreck over this. The more I read about these surgeries the more I want to just throw my hands up in the air and say "FORGET IT"!!!!!! So if you have one and could email it to me I would be most appreciative. gina0922@cfl.rr.com

Hi Dee, I will definitely have to keep up with your journey with Horizon BCBSNJ as I have them as my carrier also. I spoke with a rep from the ins comp myself and was told it was excluded unless it is medically necessary. I called my HR person because I wanted to know exactly what the insurance would require of me such as the 6 mo Dr supervised diet (secretly hoping they would say, "No that is not required") before I paid out any money. I got the email yesterday that the CPT codes (Band and RNY) I sent her were not covered. But I should have my DR to send in a pre determination letter to verify. So now I don't know which way to turn either. I requested an insurance booklet from her today. I want to see where it say that. Is there a difference between "Not Covered vs Exclusion or Excluded" Because she definitely said unless it is medically necessary. But then again, they told you that 3 times.

My heart goes out to you. I am still pre-op and undecided if I will choose LBS or RNY. So I cant give you any advice as to this phase you are going through. I can only say I am sending you a great big {{{{{HUG}}}}} Stay strong and remember that the ones who love you will always be there in your corner. They will understand that this is something you are going through and this is not your normal behavior. They will be there when you come out of this and their arms will still be open wide for you! Hugs! Gina

Hi Kim, I'm from Shelbyville too but I'm currently living in Melbourne, Fl. I lived in Shelbyville for 23 yrs. You know you really are from Shelbyville when you start calling it "Shebvull"! LOL Well, I actually lived outside Shelbyville in Petersburg for my last 8 yrs in Tennessee. My daughter still lives in Shelbyville with her husband. I would move back in a heart beat too! Florida is a great place to visit but that's about it to me. I am at the beginning of my 6 mo diet. Hopefully will be banded in Sept. I just wanted to say hello, best of luck to you! Gina

I really enjoyed your blog. Gave me somethings to think about. I'll most likely still have the surgery though! Hopefully, there won't be any fire alarms. I can deal w/the cath if they do it after I am out and remove it before I wake up! Hugs, Gina

You didn't have to do a 6 month pre op diet? That would be great if I could get by without that! I will have to call my Insurance and see what the requirements are. Gina

Hi Tee, I have Horizan bcbsnj and I live in FL. First let me say that I have checked my policy for cover to cover and there are no exclusions to any form of weight loss surgery. The website shows 10 hospitals that have Bariatric Centers that are in network, so I'm ok with that part. What does concern me is that you mentioned that Horizon stipulates you must provide proof of any and all methods of weight loss over 5 years. I am uncertain how I am to obtain this as I have never been to Weight Watchers or Nutri Systems or any other type of weight loss system. I have tried other methods at home such as different types of diets like Lowfat, Lowcarb, OTC diet pills, exercise videos and such. My entire adult life has been involved with some type of weight loss plan. So, do you have any idea how I would get past this part? I have all or atleast many of the co-morbidities associated with being morbidly obese. I appreciate any bit of information you would have. Thanks, Gina

Wow! Those are some long hrs! I work in a call center too and only work 9am to 5:45 w/2 15's and a 45 min lunch. I was told by another bander that as long as your job is not physically strenuous you can go back in a week. Best of luck to you! Gina

I would love to have the confidence to walk naked in front of my husband for once in our 10 yr marriage. I want to make love with the lights on. Sorry but I can't stop at 2! I want to to buy blouses that look good not because they are long enough to cover my hanging belly. Pretty strappy sandles with high heels instead of flats because my weight is too much to put on the balls of my feet. Oh there are so many things I want. But the one I truly want the most is to be alive. Hugs, Gina

I plan on having my LBS in Ocala, which is about a 2 hr drive from from where I live in Melbourne. The Dr I am going to be using is Dr Jawad. He also has an office in Orlando. Just do a google search for Dr Jawad. You should get the info you were looking for. But I am not sure about the BCBS covering the fills. Hope this helps! Gina

Hi can someone ehlp me? I have been trying to post a pic in my profile but I keep coming up with "Unable to save file". I know the pic is within the 97kb and the 100x100 pixels. Any suggestions? Gina