Cloteal

That is so great to hear!!!!!!! I am so happy for you... I am still waiting on my drs office.. They said my file is still floating around... I have called 2 days in a row. Guess I will just call everyday to remind the lady I am waiting to hear when she sends my info to the insurance company. Please pray for me...

Thanks so much.

Yes, I will keep you in my prayers.

For those that care and those that don't, I can finally can leave you alone, I know I probably was worsen, but I'M APPROVED!!!!!!!!!!!!!! Thank all that prayed and was concerned. My surgery date is still scheduled for tomorrow. I will keep you posted.

I am sure you will be approved... cause if they said you didnt do the nutritionist or psych eval - then you would have def been denied... I am praying for you!!!!!!!!!

Thank you for your prayers. I will be praying for you to.

Thank all of you that prayed for me and who were just as anxious as I was, but no, I was DENIED! The reasons they gave was a bunch of mess. My BMI was a 40.6, for the past 4 out of 5 years it was a 40, besides now I have high blood pressure which I am now taking meds for, along with acid reflux. Don't know what happened. I called the insurance co to see why they denied my approval they said, because my BMI was below 40 with no comorbidities. Come on the paperwork is right in front of you, I had 2 doctor letters of recommendations stating all these facts, the letter from the surgeon stating that my bmi at that time was a 40.6 and that my blood pressure was high then too. The insurance co also stated that no psych eval was done, no nutrionist eval was completed, which is all false. I was in the surgeons office on yesterday for my group eval, when I was given this news. The clerk there showed me my packet everything that was sent to the insurance co. Nothing in that packet showed my bmi below a 40, the letters from my PCP was there, the psych eval was there, the nutritionist eval was there, WHAT WAS THE INSURANCE CO LOOKING AT? Well, they told me that they were going to do a (PCR) patient courtesy review. I should hear something Monday. I told the insurance co, someone is either falsifying info on my paper or someone is not doing the review. Based on the BCBS policy I meet all requirements. I don't know what else to do. Guess I will be appealling.

The pain is no that bad... I'm so excited I finally to the plundge after the war with bcbs... I am so looking toward to my new life

Congrats to you!!!!!! Sorry you had to war with BCBS, but you got through it. I'm probably where you were months ago, I'm having the time of my life with BCBS. How did you ever do it?

Congrats to you!!!!!! I'm sorry you had to go to war just to get this done. I'm where you probably were, I am have the time of my life with BCBS.

Ok you guys here is another update, I went to my PCP today to get the additional info that they (the insurance co) requested. My blood pressure was up, they had to put me on BP meds (a plus for me). Now don't get me wrong, I don't won't high blood pressure, but if this is what's going to help me get approved. The acid refux yall is a very terrible feeling, they put me on meds for that as well. My PCP said she will write a letter regarding these issues, and will put on there that this is do to weight gain. Yall pray for me that this will help me get approved. I'll keep you all updated. So far as I know my dates have not changed for surgery, which is 08/13.

Interesting. I wonder if a trip to your primary and a medication for HBP would do the trick. Have the criteria changed? I know that I was a tad below 40 with no comormidities and was approved. Or maybe the blood pressure readings? I don't think it will delay your surgery. Just attention to details. But then I'm not an insurance person. Does the insurance specialist have any suggestions? Or your doctor?

No, they didn't give me any suggestions just to revisit with my PCP. I will call Monday to get an appt with my PCP and hopefully she will put me on BP meds. I had my BP checked today at the Drug store and yes, it is still high. I know they say the normal reading for High Hypertension is 140/90. My BP read today 147/95, this is low compared to what is't been. It usually run around 165/106, somewhere around that. Hopefully this will work, just pray for me. How are you doing?

Update. Received another call this evening from my surgeons office, yes BCBS requires additional info on my blood pressure and acid reflux. My primary care provide don't have anything else, I wasn't on any meds as we figured if I get this surgery then my blood pressure would go down. Besides I was only borderline hypertension that could be controlled with eating right and losing weight. Just the past month or so it got really out of control, I didn't go to my Doctor as I didn't want to go on meds (dumb me), but I felt I had a good chance of getting approved. I don't know now what to do. Can anyone help.

Ok you guys, I received a call today from my surgeons office stating that the insurance company need more info before they can approve my surgery. My surgery date was set for 08/13, now that'll probably change. The insurance co is requesting more info from my primary physician, well that info is a 5 year weight history, and a referral letter, I provided all that info to my surgeon, why is my insurance co still requesting that info. I'm wondering if the surgeons office didn't send all my paperwork in. I'm very frustrated and now concerned that I may not get approved. I met the qualifications, I thought, my surgeon said it shouldn't be a problem getting an approval. Then what is the problem! Thanks for listening, just needed to vent.

Great News!!!!!! I am approved, Aug 13th is the day for me and my first part is over. Now I am going to work on being healthy forever.

YES!!!!!!!!!!!!! Congrats to you. I am so excited for you, hopefully we can Celebrate together. Pray that mine get approved to.

We must be doing something right, I got a call yesterday and my surgery date is 08/13 also (yes!!!!!) Same hear as long s the insurance comes back. I am so excited until I could burst at the seams. Where are you being banded, well I will be at Rex, maybe we can call each other after the surgery.

I'm being banded at Duke, and yes we should call each other afterwards and maybe the night before to see how calm we are (smile). Seems like things are picking up for us.

Update! I finally got a call on yesterday, my surgery date has been scheduled for 08/13 (YEA!!!!) Don't know how to post a smiley face. They said that the only way my date will change if my insurance doesn't come back approved in time, but they don't see why it wouldn't they have everything they need (YES). I'm finally excited, keep me in your prayers.

The Rex's deductible can be billed. I just had all my bills (deductibles) set up on payments...hospital (Rex) and the

Anesthesiologist. Now the doctor's office is another thing. I had to pay my surgeon's deductible up front. Be specific. Is it the surgeon's office that requires their deductible up front or the other areas (Rex, anethesiologist, lab work, Xrays, etc.)?

The hospital where they will be doing the surgery (Duke). I'm not referring to the co-pays. How much was your deductible prior to surgery? And this info that you don't have to pay your deductible upfront came from someone that works for BCBS of NC.

I spoke with the insurance company before I started this process and Dr. Moran is in network. So if I have this right I can be billed for the deductible. So should I continue to go ahead with this. I am getting really frustrated.

I would continue to go forward with it. Just as Flipp said, she works for BCBS and they do not require you to pay the deductible upfront. It is totally up to the hospital, some will try and make you pay up front, hopefully mine will not. I'm going to move forward and pray for the best. I would listen to Flipp though as she works for BCBS.

Who was your doctor, I am consulting with Dr. Moran on today and had my appointment with nutr. on Monday. My physch eval is on tomorrow morning. The last appointment I have is on July 23rd with the cardiologist. I am so close but seem so far away. I am hoping to go to Rex. I do know that some of the doctors use the hospital in Louisburg also.

My Dr is Sudan out of Duke. I already seen the nutritionist, and had my Psych eval, just waiting on approval from insurance co. Did you read the previous post from FLIPP, she's a bander here and she works for BCBS of NC and said that it's not required to pay the deductible upfront, but depends on what hospital you go to they might refuse surgery if you don't pay. I'm praying they can bill me, I'm really not in a position to pay the deductible upfront right now. I have a daughter who starts college in August and I have to be prepared to assist her. That will be more important than me getting this surgery. Don't get me wrong, this is definitely important, but college comes first.

It really depends on the hospital. I went to Rex in Raleigh and they asked me to pay something towards my ded and I told them that since they are in network that they have a duty to file a claim first and then bill me. If you go somewhere else it's possible that they may refuse service without a payment, but per their contract they are not supposed too.

I'm going to Duke, I'll just have to wait and see. Thank you for that info.

I haven't been on here in a while. But I finally had my surgery 07/01. So far I've lost 15lbs. I didn't pay anything upfront, but that is because I refused. Since I work for Bcbsnc I know that if you go to a provider that is Inn network then you're not required to pay upfront and alot of people don't know that so they pay their deduct upfront. When your ded starts over depends on what policy you have, I work in the state health plan department and their ded started over 07/01/09, but my policy won't start over until 01/01/2010. So call and see if you're on a fiscal year or calendar year. I've starting receiving bills my surgery total was $36,642 and my part is $3500 which isn't bad. I get my first fill 08/04 and I'm ready:thumbup: Since my swelling has gone down quite a bit I'm starting to get really hungry:crying:

Congrats to you. I know I'm on Fiscal and my policy started over on July 1, 09. I'm glad you told me that I'm not required to pay my deductible upfront, but can they refuse my surgery if I don't pay upfront? I'm still waiting for BCBS approval, as far as I know, they sent my paperwork to them over a week ago. Just trying to be patient. Thank you so much for your input, it really help rest my anxiety a little. Keep up your good work and please update on your progress.

Hi, I'm getting banded on 8/11 and have BCBSNC. My BMI is 39 and I have no pre-existing medical problems. BCBSNc approved me with no problems, don't know if the staff @ my doctors office pushed it or if the insurance just approved it, but either way, I'm approved!!!!!!

Good for you. I'm glad to hear that, maybe I still have hope. I'm just waiting on the approval from the insurance company. Being that our plan changed on July 1st, do you know if you have to pay the deductible up front? And who are you going through to get your surgery done?

I am not sure if the deductible has to be paid before you can have the surgery but I can find out and let you know. I am closer than I have been in my entire life.More excited than anything.

Thanks. I would really appreciate that.

Yes, I have to pay $600.00 for my deductible and $60.00 for my regular visit on the 24th.

I was just wondering, because I'm hearing several different stories about paying upfront or being billed. I didn't know you had to pay your total deductible upfront. I had another friend of mine who has bcbs of nc and paid nothing upfront, but got a bill in the mail, that's why I was asking. I was never told though by the dr's office that I had to pay anything but for the psych eval upfront.

I have BCBS of NC and the total process took about three and a half months. It took two hours for approval. :smile2: The waiting is the worse but its worth it in the end. My surgery is July 16th so right around the corner. I'm so excited. Good Luck to all of you and keep updating.

Do you have to pay anything upfront? Like your deductible.

I finally heard from the doctors office and I will have my consult on June 15 and have to pay a $250 program fee, with both of my insurances I am not sure how much my deductible will be. Hopefully I will be able to go ahead and get my nut eval and physch eval before long. I will probably have to be cleared by my cardiologist also so I will have to do that.At least I know that they are working now on this stuff.

If you don't mind me asking what is a program fee?

I have BCBS of NC and the total process took about three and a half months. It took two hours for approval. :biggrin: The waiting is the worse but its worth it in the end. My surgery is July 16th so right around the corner. I'm so excited. Good Luck to all of you and keep updating.

Thanks for the info, but is that 3 1/2 months including the initial orientation/consultation and all appts etc? Who are you going through to have your surgery done?

UPDATE!!!! and conflicting stories. I just received a call from my Surgeons Administrator who is responsible for sending the packet to the insurance co., well it has not been submitted yet as she was waiting for a clearance from the Psych Dr. and Nutritionist. I was just told earlier that the packet was already sent to my insurance co and they were waiting on approval, well that hasn't even been done yet.