taylormomto6

They won't require another 6 month diet. This one will carry over, as long as you attend all sessions. Now my medical group also requires another 3 month class after the 6 month one, but they've been upfront on that. I don't have HealthNet, but my sister in law does. We live in the Bakersfield area and she has a different medical group than I do. She was just approved after one appeal without a 6 month diet, they never even mentioned it. If I had known hers doesn't require the 6 months, I'd have gone with them to begin with, my PCP belongs to both groups, but I think Blue Shield does require the 6 months anyway, so I figure I'll complete it and if they deny me even after appeals, I'll switch then :biggrin: Good Luck to you, Cindy T

This is my Medical Group that requires this stuff. I spoke to my PCP and he said they can't deny me for not losing that much weight. I'm thinking I'll attend all the classes and if they deny me at the end of all this, I'll appeal to the insurance company. I have Blue Shield HMO and they do not list these things in their requirements. I have the complete support of my PCP as well as my gynocologist, so I'll get letters from them as well. If I have to I'll go to Obesity Law and inlist their help. Cindy T

Well, I attended my first class yesterday and found out that after the 6 month diet, I have to attend a 3 month pre WLS class as well. In addition to attending, in the WLS class you are required to lose 20% of your weight before they will approve surgery. Absolutely no surgery is performed without the 20% loss, no matter how long it takes you. That is on top of whatever weight you lose in the 6 month diet class. When I asked them if losing weight in both of those classes would make someone ineligible for WLS, they said that would depend on your starting weight and how much was lost, but yes, it could make you ineligible! GRRRR...these people are very sneaky....they do set a very moderate goal of 4 lbs a month in the 6 month diet class, but thats still 24 lbs gone. Then an additional 20%, for me would be another 48 lbs gone for a total of 72 lbs., which would put in the 190s and probably ineligible since I don't have diabetes, sleep apnea or severe heart problems. Unless a person weighs 300 lbs or more, I just don't see how you can approved after all these requirements. Why don't they just say you have to have a BMI of over 50 to qualify, that would at least save a lot of people the trouble. So, now I'm at a loss as to how to get these classes in, lose weight, but not too much....geez! The only "good" news was that when I used the online calculators for my BMI, it was 43.7, but they had me hold this thing to measure BMI and it was over 47. Now thats not normally good news, but at least that gives me a bit more wiggle room. Very Confused, Cindy T __._,_.___

I understand your frustration! You are doing the right thing by changing medical groups. I would be sure to choose a new PCP that is supportive of WLS. Be sure and go to every appointment for your 6 month diet. Don't give them any excuses to deny. Good Luck!! Cindy T

Thank You mesaucy. At least I know where my surgery will be LOL. They are giving me the runaround already. Got a letter yesterday requesting I call "for an appointment"...when I did she said I had been put on a waiting list...no, I had already been signed up. Anyway, I go in today for measurements and I think she signed me up for the class...who knows. I'm also out of town, 35 miles, so this is going to be pricey. I'll update later after my appointment. Cindy T

OK, well at least I finally got approval to join the medical groups (Bakersfield Family Medical Group) Weight Management program. It doesn't begin until July 17 though. These people are seriosly trying to get us to lose weight without the surgery. The first 9 weeks is a weekly class on nutrition and exercise. All food and exercise must be logged in a journal and they do measurements and weeekly weigh ins. Then it moves to every 2 weeks where I'll meet with the Health Education Centers rep for the remainder of the 6 months. At anytime that the consider I'm not doing so well, they refer me to the nurse:mellow: I guess for a beating lol. I'm guessing during this 6 months I should not let my BMI drop below 40? Then, I believe they will put me through their WLS teaching class as well. At this time they'll do the psyc eval. After that I'm guessing will be the medical tests. Then I guess they'll approve or deny. mesaucy- since you have BS Ca HMO, do you know a surgeon that takes this insurance? Actually, I think they even have to be contracted with the medical group. They really are trying to trip you up it seems. Making it difficult so they can find an excuse to deny. Well, there's my update. I'll add more after I start the Weight Management class. Cindy T

Thanks peg, yeah, I'm not at all upset about the 6 month diet. I understood that was going to be a requirement and I agree, it'll be informative. I'm most interested to know if others that have HMOs have had to go through their medical groups like this. If they accept me into the "teaching program" does that mean they will approve me as long as I jump through all the hoops? I called them today and they said they received the referral a week ago and it should be processed today, so I'm thinking approval for an educational class should not be that difficult if entry into the classes wasn't a type of preapproval for the surgery (of course that would be dependent on all the hoops being cleared). I also still do not know where the surgery is done. Blue Shield lists no bariatric surgeons that accept HMOs within 250 miles, so I'm not sure where they send us. Of course there are several nearby that accepts Blue Shield PPOs, but I just can't squeeze out another 200 month to change it right now. Anyway, I guess I'll find out soon enough. Cindy T Maybe I'm just wishful thinking:embaressed_smile:

No one has had to go through their medical group like this? No comments?? Cindy T

I have BS HMO and just filled out the "weight loss surgery education criteria checklist" with my PCP to see if they will accept me into their program. If they accept me, I'm to join their 6 month weight loss class and simultaniously attend wls education classes at the medical group. Apparently the educators will then submit a psychological profile on me to qualify me for surgery. I must attend all sessions, comply with all assignments and exercises as determined by the counselor, show that I will be able to practice necessary post op lifestyle changes and not have any significant psychological problems. I looked at the website of my medical group and the next weight loss class begins in July. Not real thrilled about waiting until then, but thats the way it goes. So the best I'm looking at is a surgery date after Jan 09. Anyone have to go through their medical group like this? Cindy T

You all have been so helpful. I realise there are success stories with each WLS. I guess my job is to figure out where I think I'll be successful. I'm just so afraid I'll make the wrong choice. I'd be lying if I said that the rapid weight loss that comes with RNY wasn't appealing. Heck, I spent half my childhood praying to God each night I'd wake up thin. I'm not so crazy about the vomiting, but from what I read, thats from overeating. I'm not overly concerned about the recovery, I don't have an outside job to get back to. I like the idea that lap band is adjustable. Not so crazy about a foreign thing being in my body that can slip or erode. Also of concern is that if something happened to my husbands job and we no longer had insurance, how would I get fills...etc. We've just now been able to get insurance and may not be able to afford it at a different job. With RNY thats not an issue. I feel confused. I'll keep researching and hopefully come to a decision:blushing: Thanks Again!! Cindy T

I am having a hard time deciding whether I want Lap Band or RNY:unsure: I think I'd prefer the band, mostly because if I have complications that I just can't live with, it can be removed. But I have failed at "watching my diet" so many times, I'm afraid I'll be a failure with the band as well and that I might be more successful with the RNY because of malabsorbtion and more limits on food choices. This is my one shot and I feel nervous that if I get the band and am not successful, I'll wish I had gotten RNY, but it'll be too late and a second surgery later is not possible for me. I am not someone who can't diet, heck I'm a professional dieter. I could teach classes! I stuck to Atkins for 18 months once, but like always, I revert to my old ways. I've done low fat so many times and have probably lost 1000 pounds in my lifetime, but I've never once maintained my losses. What makes me think the band will change that?? How did you choose?? Cindy T

Thank You! That makes me feel more encouraged. I'm not concerned about the morality issue. If I must, I will find a way myself. I've been over 40 BMI for most of my life and spent a good amount of time trying to dress to hide it. I find it ironic I am now concerned about proving it:laugh: Cindy T

5 years worth medical records BCBS Have any of you with BCBS (I have Blue Shield Access HMO and am in CA) been approved without 5 years worth of records. Does it have to be the last 5 years? I have not had insurance and maybe have 1-3 doctors visits during this time. However, since I've had 6 kids (starting in 1981 and ending in 2000) I can get them weight/blood pressure records in 9 month increments from the obs office:blink: I really hate to think I'm going to have to wait 5 years to begin this process. I believe I'm a great candidate for surgery and my BMI is 42. Thank You! Cindy T

Please ignore my post above. It was not intention to post that in this thread. Just one more example of how the mind begins to go at 45:wink_smile: Cindy T

Have any of you with BCBS (I have Blue Shield Access HMO and am in CA) been approved without 5 years worth of records. Does it have to be the last 5 years? I have not had insurance and maybe have 1-3 doctors visits during this time. However, since I've had 6 kids (starting in 1981 and ending in 2000) I can get them weight/blood pressure records in 9 month increments from the obs office:blink: I really hate to think I'm going to have to wait 5 years to begin this process. I believe I'm a great candidate for surgery and my BMI is 42. Thank You! Cindy T

Thank you so much for the encouragement. I really appreciate that!! Cindy T

You guys are so helpful and I'm learning so much.:wink_smile: Since we've had no insurance and spending our money raising our kids, I had zero chance at getting surgery before. Now at least I can have hope. I am so sick of trying to convince myself to go on yet another "diet" and dealing with the feelings that I know its just going to be another failure. I've failed so many times that my confidence that anything will actually work is rocked. I am still fighting the feelings that tell me I won't even be successful with the band. Maybe I'll stop losing again, no matter what I'm eating...maybe I won't be able to control my eating, I haven't been able to yet...and the list goes on. I'm by nature a very positive person, but all the years of diet failure has caused serious doubts in ability to lose this weight. I keep telling myself that these feelings are normal, I mean afterall, each successful bander has failed at diets pre band right?? Anyway, I've rambled long enough:embaressed_smile: Thank you all, Cindy T

Thank You, that is very good information to know:thumbup: Cindy T

I see. Then if you turn in the paperwork, it will be looked at and decided if they have a good chance at getting paid. If so, they set you up a consultation appointment, I'm guessing for free as well, to kind of "reel you in"?? Will they still need the referral? Thank You, CIndy T

I am just beginning this journey and am wondering if being hypothyroid can affect whether or not you can be a candidate for surgery? Thanks, Cindy T

I'm sorry I don't have the answer for you, but I just want to say you are not alone. I have also been without insurance therefore been without medical care and am just now getting Blue Shield Access HMO through my husbands employer. It is supposed to take effect today, but I have not yet received my benefits card. I can tell you that on the benefits paperwork they gave DH, it does state weight loss surgery is covered if medically necc. I believe the 5 years is to show you didn't just suddenly gain weight, that it has been an ongoing problem. I could get records from ob/gyns that cover 20 years, just not the last 5, so I guess I'll just have to see how anal they want to be and keep appealing if they don't approve it. Good Luck and I'll be watching your responses. Cindy T

Whisper- I can go have a visit with one of the doctors at the seminar without a referral from my PCP? Hmm, I thought I had to get the referral first with an HMO. See, I'm learning already:laugh: I have BS as well (Blue Shield Access HMO). As far as the 5 years...if that would be the last 5 years, I'm just out, but prior to that I think there are some records. I did see a doctor for Phentermine and failed, went back to the same doctor after a year on Atkins because my weight loss stopped. He did labs and found me to be hypothyroid. There was several doctors visits involved there. Then a year later when my prescription ran out, I went to the clinic a few times for labs and thyroid meds. Of course, I've had 6 kids in 18 years, so I could get those records that document my weight, not to speak of 25 years of pictures:scared2: I think you are right though, I think I'd have better luck with the bariatric surgeon pushing the paperwork rather than my PCP. Afterall, the surgeon is the one that will get paid, not the PCP. Fairy- I will check with HR, but the paperwork on coverages I received from the employer states it is covered if "medically neccessary". I do need the insurance anyway though, as there are other issues I need to have looked at (vaginal prolapse, lower back pain, strange skin problems I believe are yeast related and several other lil issues). Thank You both. You've been very helpful!! Cindy T

Thank you so much for the reply!:puke: I will do just that. Also, there are 2-3 seminars in my area, so I think I will attend each one. This way when I'm ready to ask for a referral, I will have already chosen my surgeon. Thanks again. Cindy T

Thank you both for the replies:smile2: Wheetsin- yes, the first thing is to get the physical for sure. I have already chosen a PCP and will be making an appt as soon as I get the insurance card. Tulip- I think that is a very good idea. There are at least 2, maybe 3 seminars in my area. I also plan to attend each one before I ask my PCP for a referral. Thank you so much for the encouragement. Cindy T

I posted this in the beginners thread, but wanted to post here as well. obese all my life and just got insurance<!-- google_ad_section_end --> <HR style="COLOR: #d9d9d9" SIZE=1><!-- google_ad_section_start -->For years we passed on purchasing medical insurance at DHs work because we simply could not afford it, but at we are 45 now and problems are cropping up:ohmy: This is going to cost us 100 dollars a week for just the two of us (The kids are covered under the "Healthy Families" plan) and I'm not quite sure how we'll afford it, but like always, we'll manage. But I figure II need to make the most of the insurance and take this opportunity to get lap band. I mean heck, after surgery my food intake will be restricted and that will reduce the grocery bill, helps cover the cost of insurance:laugh: Our insurance is Blue Shield Access HMO with no deductable and the policy takes affect April 1st and states Bariatric Surgey as covered when medically neccessary. I am 5'6" and weigh about 262, so my BMI is over 40. I'm hypothyroid (been treating myself the last 6+ years because of no insurance through mexican pharmacies) and really don't know if I have any real med problems since I haven't seen in a doctor in years. I have been obese since I was about 20. Been on many diets (at least 30), lost lots of weight and regained just as much (including losing 77 lbs on Atkins in 18 months about 5 years ago). The only time I was treated by a doctor for weight control, I was given Phentermine and I think that lasted 2 months). Since I am completely new at having insurance at all, I'm not sure where to begin. I have not yet received my insurance card, but when I do, I assume my first step would be to make an appointment with my PCP. Should I speak with her about lap band on my first appointment or should I establish a relationship with her first? Should I request a weight loss program? What if I lose too much weight? I know I can lose weight in 6 months, but it'll be back by 9 months. Your thoughts and comments will be appreciated. Thank You, Cindy T<!-- google_ad_section_end -->