wannababy

So....I heard from my surgeon's office today, who talked to BCBSIL today. They said I need to fulfill my 6 months supervised weight loss program, which is ONE more visit with my Primary Care Dr. SO....not the news I had hoped for, but the second best news for sure. They could have just flat out denied me. I was hoping they would count my Weigh****chers, but they said it had to be DR supervised, which was not a surprise either. It seems as if they are going to take 6 visits rather than 6 full months (180 days), so that is great news, hopefully they will follow through with that anyway. So I have an appointment with my physician on Sept 2 and then hopefully we will get this to ins asap and get a quick approval... That is my update. I am very excited, but yet trying to be somewhat guarded b/c I won't be 100% until I have the approval paper in my hands. Thanks Amy

I don't have specific answers to your question, but thought I would comment. I am going to a Dr in St. Louis and his self pay charges are $15550 for inpatient which included fills for lifetime OR $14550 for outpatient, without lifetime fills, but could add $1000 for lifetime fills, so the same price for inpatient vs outpatient with the lifetime fills. Where are you in KY? Good luck!! Amy

My Dr's preop diet is 7 days, Clear liquids only. I only get chicken broth, sf Jello, low cal juices, other broths, Water, tea, coffee..NO MILK Products. Basically No to low calorie. Extreme, I know, but that is what he requires... Amy

Perky66- Your counseling with the nutritionist is the same requirement as the counseling I have with my Dr., I think. I did not need a sleep study, but I did do the psych testing. I am sure hoping for a very quick approval after my Dr appt on Sept 2nd. I know I will have some out of pocket cost, b/c of my High deductible plan, but I know about that, so... Thanks for your post!!

That is great news!! Congrats!!! I heard from BCBSIL today too. They said they need one more Dr visit to approve me, so I have to send that in after my next DR visit on Sept 2nd, then I hope they approve me too!! Congrats again!! Amy

I have been wondering two things: 1. Do we have to get a catheter for the banding operation? 2. Do you wear underwear during the operation/what if TOM is here?? Thanks! Amy

I agree with the Previous poster, however, just to clarify, although there are no copays with PPO, it can be deceiving, b/c you still most likely have to meet your deductible. In my case, I have an out of pocket cost of $2500 before insurance kicks in, so although I don't have an actual "copay" it is still a load of $$. Insurance is complicated.... :thumbup: Good luck! Amy

Congrats on the approval! That is a beat feat in itself!! Hope you get a surgery date very soon! Amy

Welcome!! I also had to do a supervised Diet/exercise program, although mine was/is 6 months... :thumbup: Are you planning to meet monthly with your Dr? I know that was a must with mine to qualify. Good luck! Amy

I think it would be good to look at the Insurance forums here, but the overall best thing is to contact your insurance company--either call their number on the back of your card or look at their website and they should be able to mail you the exact requirements. Here is the link I found that states their info, but I would still call to double check: https://www.bcbsnc.com/services/medical-policy/pdf/surgery_for_morbid_obesity.pdf The reason I asked who it was, is b/c I have BCBSIL and have to complete 6 months of dieting/exercise with my Primary Care Dr before I can attempt to get approval. Lots of insurance companies do this, so that seems to be a very common starting point for most people. However, I did not see that in your policy, but like I said, I would check with them for exact policies... Good luck in your WLS journey. Amy

Which BCBS do you have? Which state, and PPO/HMO, etc. Do you know your insurance requirements? I am planning to get the Realize band very soon too. I have BCBSIL and working through their requirements right now, but hope to have my band in sometime this fall. Good luck Amy

My surgeon's office said that with BCBSIL PPO, you don't have to go through the appeals process if you just need to add add'l info, even if they denied you at first. Just add additional information for them to review and if you do what they ask, you should get an approval. HTH. Amy

Bubbly--Congrats!! How exciting! Your surgery date will be here very very soon!! Would you please post your story with BCBSIL... My paperwork was sent in Wednesday, and I am anxiously awaiting their decision. I would like to hear your experience with them. Thanks!! Amy

I would encourage you to keep a journal...everything that goes into your mouth gets written down. Likewise, I would also journal when you PB, exercise, everything. If after reviewing that yourself, you are still having problems and everything looks like you are eating/exercising correctly, then I would show that to your surgeon and he should have some more feedback, when he has facts to base his information on. Good luck!! Amy

YAYYYY!!!! Congratulations!!! That is a big sigh of relief, I am sure! Glad to hear that worked, b/c I am right there with ya! Insurance got my stuff on Wednesday, so I am anxious to hear!! Thanks for updating. Do you have a surgery date?? YOU are going to have GOOD weekend!!! Amy

My surgeon did say, there is less discomfort near the port, after surgery with the Realize band for that reason. I guess that makes sense too.

I am planning to go with the Realize band. I think they are both very very similar, but have just a few differences. The Realize band is supposed to have less slippage and PB occurances, b/c it has a little more "give" in the band. Also, the port clamps into your muscle, whereas the LB is sutured...it is suppose to cause less port flipping. And of course the Realize band has the support software..which I am sure LapBand is soon to follow with that. Like I said, slight differences, but my surgeon thought they sounded worth it. Good luck! Amy

That is AWESOME!! Great job! Hopefully I can be as successful as you have been... Congrats! Amy

I was very unsure of how my parents would react, and suprisingly, they are very very supportive. My parents both said they have seen me struggle for so long that they are just glad I am doing something about it. I was very shocked, but so glad I told them, and now it is a huge weight off my shoulders.... Good luck! Amy

Hello! My surgeon's office just called to let me know they sent my paperwork to BCBS IL today!!! They said I should know something in 2 -4 weeks... gosh, the waiting is agony, I am sure!! Also, they said they weren't sure what to expect because, I have only completed April 25- August 1 (technically 5 months), of my supervised Weight loss plan with my PCP. BUT, I started Weight Watchers meeting in January 2008, and have stayed on that until present, so I am hopeful that will mean something! Worse case scenario---they deny me and tell us we need one more month, and I do that, and hopefully then get an approval!! Everything else should be okay...BMI for 5 years and all of that stuff. I am hopeful! Thanks for reading! Any thoughts/feedback?? Amy

Illinoishusker- I talked to my surgeon's office last week. She just got off the phone with BCBSIL regarding another patients approval and they told her, it didn't need to be 6 month together anymore, just a total of 6 months within the last 24 months. So hopefully you will be okay. I am hopeful for you, and can't wait to hear!!

I am sure it is tough...I haven't been there yet, but I would stop...now. My surgeon told me he had someone do that, he went in to do the surgery and his liver was huge b/c of the food the guy had been eating for the last couple of weeks. He closed him back up and told him to come back after a few weeks of a preop diet. I would sure hate for that to happen to you.... Good luck! Amy

Wow, that is great! Congrats!! reading these great posts, makes me more anxious to get my band!! I am awaiting insurance approval....I can't wait! Good luck with your continued success... Amy

Is there ANY way you can pay that with a credit card, or ANY way possible. Something...? I know it might take a little while to pay off the credit card, but it would def be better than jeapordizing the entire thing, and still is MUCH better than a self pay option. I know people who don't have coverage and have to pay $20000 for the procedure. Plus, really it is only $1000 for the health insurance, the $800 you owe your company for your expenses that they already paid. I know it might seem hopeless right now, but I would try to do anything possible to continue your insurance, for more reasons that just lapband too. Good luck. Amy

We are a fan of Muscle Milk, Cake batter flavor. Mixes up smoothly and tastes much like a sweet milk. I love to add instant coffee grounds and ice to it, and make something like a frappucino...ymmm... I have been trying to drink at least one per day as a Meal Replacement, usually in the AM, and I have really grown to enjoy it. And it also makes me feel sooooo much better. ( I am still preop too). Good luck. amy