Cloteal

I have bcbs of north carolina and I work there. It only takes a few a days to get an approval once your doctor sends in the info. Dr. Enochs office sent my paperwork this Monday and I was approved Tuesday. It only takes longer if it's denied and they have to file an appeal. I didn't have to have a 6 month supervised diet, I just submitted my medical records to show my bmi for the last 2 years, had all the tests and evaluations. I have an appt 05/19 to schedule, I'm hoping for a June surgery date!!!:cursing:

Can't wait anylonger, did you get your June surgery date?

Wow, this question was an eye opener. I haven't been banded yet, in the process of being banded but never did I think about the scars and that there's going to be an object inside of me that you can actually feel just by rubbing the outside. I to am married and I don't believe any of this will be an issue for my husband, but for me it was kind of a scary thought that the scars could be that huge and noticeable. How big will the scar be?

since you're going to Duke, just a couple of other bits of information. I just trusted the doctor about the band. I finally asked about it my last appointment. I got the 10CC lapband AP and with a single incision surgery. Once you get the appointment, the process moves really fast. I saw the doctor the first time on 12/22, mainly because someone canceled. I had tests run on 12/29, and was approved on 12/31. I was originally scheduled for surgery on 1/9!!!I actually think I was the one to ask them to slow down! I needed time to process the dietician info. the psych info, the testing, the group meeting, etc. I had the surgery 2/19 at Durham Regional. The surgery is either at Duke or at Durham Regional. I preferred Durham Regional mainly because it is sooo much easier to get into and out of. Duke is a hassle with parking.

Thank you for that info. If the process goes fast for me I will be ready. I'll keep you posted on my approval etc. Keep up the good work with your weight loss, looks good. Oh, one more thing, did you have to pay for the psych eval up front and what else did you have to pay for up front if any? My insurance co will pay 100% in network, out of network 80%, which Duke Psych Dr's are out of network. So I have to pay $350 upfront for the psych eval.

Cloteal,

My insurance is Midlands Choice (a.k.a. Mid-America Benifits) and they said they no longer cover ANYTHING having to do with obisity...be it surgery or meds or anything and I am havin' a really hard time getting any help or an up to date copy of my policy. The insurance is through my husbands work and even they don't have a recent copy.

I wouldn't get discouraged, there was a time when my insurance company BCBS of NC didn't cover weightloss surgery, now they do. Just hope for the best, whether it be now or later. Something will come through for you just have faith.

I have bcbs of north carolina and I work there. It only takes a few a days to get an approval once your doctor sends in the info. Dr. Enochs office sent my paperwork this Monday and I was approved Tuesday. It only takes longer if it's denied and they have to file an appeal. I didn't have to have a 6 month supervised diet, I just submitted my medical records to show my bmi for the last 2 years, had all the tests and evaluations. I have an appt 05/19 to schedule, I'm hoping for a June surgery date!!!

Congrats to you. I hope you get your June surgery date, keep us posted. Yes, I did contact my insurance co which is BCBS of NC, I do meet the requirements as long as my BMI is 40, which it is. I'm going through Duke Medical Weightloss Center, as I heard they were really great (a center of excellence) and they have been good with making sure you have everything thats needed for approval. Being that they are a center of excellence they have many applicants and it will take atleast 4 weeks to even get an appt with the surgeon. But I'll keep you all posted. I know there will be someone like me who will want to know the procedure, how long it takes and what next, so I will be there for them to. Thanks so much for your post, it was really relieving to know that BCBS does not take long for approval.

I have been looking into getting the lapband done for while and finally found the doctor I want to use, but my insurance has denied any help that has to do with obesity. I was going to be able to pay for the surgery with money I had saved but in March I had kidney stones which totally dried up the money pool. I can't afford to finance through a bank either as I already have a loan out for my car and with three kids (the oldest of which is 5) money is tight enough already. However, I feel that my body needs this surgery in before the onset of diabetis or blood pressure problems become and issure. So what I was wondering is if anyone had any other suggestions on a method of payment and are willing to share their info....I would be truly greatful.

Marcy

I'm not an expert or anything, but what type of insurance do you have? And may I ask why you were denied? You can appeal the decision. Find out what your insurance company require and go from there, it may be something simple that they denied you for. Get a copy of your insurance policy.

Ok, I went to the orientation on yesterday. Received application packet, completed mine already and faxed a copy to them today and mailed the original today. Lets see how long it takes to get an appt with the surgeon. I was told yesterday that it'll probably be 4-6 weeks before we receive a call for an appt. (WOW!!!) I'll keep you all updated.

Just wanted to know if you knew the process there, about how long everything will take. I went to the orientation today and will turn my application in on tomorrow. Then what shall I expect? I was a little confused today, I have BCBS of North Carolina and I was told in the meeting today that they don't BCBS ask for a 5 year weight plan, nor a Dr's recommendation, all you need is a BMI of atleast 40. Maybe I misunderstood them. Help me understand.:thumbup:

Hey Guys, I have an update. I received a call earlier today from Duke, they had a cancellation for tomorrow for the orientation, we'll see what happens from there on. Pray for me that I don't get a airhead for the insurance specialist.

I went to a consultation at a surgeon's office and they told me that because I had a HMO that they would not even cover the lap band. So I was upset but I decided to call my insurance co. and have them look up my policy and they told me that they will cover it as long as my PCP says it's a medical necessity. They don't require any classes or weight loss beforehand. So my PCP gave me a referral and it was approved in 2 days. So if I where you I would call my insurance before talking to anyone else and ask if it is covered and what is recommended that you do before you can have the surgery.

Thanks. I know that my insurance covers lapbands with a bmi of 40+ and less than 50. I printed out the policy, and I have a friend who has bcbs of NC and had this procedure done. That's who recommended me. Do you have a surgery date set yet? Good luck to you and I wish you wll.

Hey Guys, I'm feelin really bummed today :thumbup:. I decided to get the lapband, I went to the orientation here in Fayetteville, NC and completed all the required paperwork. My doctor was even in my corner, she completed all documents needed and wrote a letter of recommendation stating that my BP is elevating due to weight gain, it's not quite high yet, but due to the weight gain it is elevating. On the paperwork it has that my BMI is a 40 for approx 4 out of the 5 years, but based on the surgeons office that I was going to go to the insurance person for that office said it wasn't good enough, and that my insurance co wouldn't approve it because based on their scales my bmi is only 39.8. That really sucks, I did everything they asked and she wouldn't even give me an appt to see the surgeon.:frown: Now, I'm sort of scared to try another surgeon as I may get turned down again. I am scheduled to go to Duke for the orientation. Anybody had any experience as such that can give me a litte advice. Thanks

Keep me posted. Sounds as though the doctor you were seeing and the Dr. I saw in Cary had the same insurance specialist. I do believe a lot of it has to do with the way it is written up. If the insurance specialist who is doing the justification doesn't believe you qualify, will she do the best job possible in presenting the information to the insurance?

You know what make it so funny, she didn't even have any of my info yet. She based it on my height and weight only. She hadn't even received the letter of recommendation from my Dr. All she said was at the time of orientation when I weighed in I was only at a 39.8 BMI. I knew right then that I wasn't gonna let her mess my paperwork up.

I was in the same boat. I had a BMI of 39, did not have a 5 year history because I worked my tail off for a year in a dr. supervised program, had terrible knees (need replacement). The first dr. I went to, Dr. enochs, I did not qualify for the insurance The appeal became such a problem with Dr. Enochs office, I switched to Duke. Dr. Enochs kindly gave me my initial fee back, BTW. I had my first appt. at Duke on 12/22, labs on 12/29, and was approved 12/31. all with the same information. I was banded on 2/19 and have lost 30 pounds. During the med. eval. at Duke, they found out I had sleep apnea. As it turned out , I did have a comorbidity. For NCBCBS, you do not have to have a 6 month diet. You do have to have a 5 year history. Joint pain does not count as a co-morbidity. I think a lot has to do with how the initial info. is presented to the insurance. JMO

Hi Skep,

I found out where to go at Duke, I have my orientation on May 29th. Hopefull things will go well. Thanks for the advise.

I was diagnosed with sleep apnea AFTER the insurance approval! I had my first appointment with Duke on 12/22/08, lab tests on 12/29, and insurance approval on 12/31/08. There is an overnight approval from BCBS of NC. I had the surgery 2/19/09 and have lost 30 pounds so far. If you're interested, look up their website. It's Duke Weight Loss Surgery. I had Dr. Portenier and can't say enough about the whole process. Duke is a center of exxcellence in bariatric surgery.

BTW, I'm a Carolina fan.

Can you please provide me with Duke information. How do I get information on the next orientation that is scheduled. I think this will be the way for me to go. I just got a email from the Surgeons office, I guess the one who is responsible for getting my information together and submitting it to the insurance co. Well, she told me straight out that I wouldn't qualify because my BMI was below 40, it was actually a 39. something. I emailed her back and told her that was incorrect info as they had my height entered wrong. I just know it's going to be some mess, so I'd rather not deal with them. What you think? I need some advise. Oh, by the way my Doctor wrote a letter of recommendation stating that my BMI is a 40+.

I was diagnosed with sleep apnea AFTER the insurance approval! I had my first appointment with Duke on 12/22/08, lab tests on 12/29, and insurance approval on 12/31/08. There is an overnight approval from BCBS of NC. I had the surgery 2/19/09 and have lost 30 pounds so far. If you're interested, look up their website. It's Duke Weight Loss Surgery. I had Dr. Portenier and can't say enough about the whole process. Duke is a center of exxcellence in bariatric surgery.

BTW, I'm a Carolina fan.

Congrats first of all on your weight loss. I appreciate all the info you've given me thus far, it is very conforting. I will have a plan B ready. I now feel so confident that I'll get approved. I have my packet just about ready, I'm just waiting on one more test (bone density). I have that scheduled for 05/14, then on 05/27 I go before the Surgeon to discuss this whole ideal. Hopefully the process won't be too long. I'm really hoping for a July surgery date.

I got approved with BCBS of NC after two refusals. This was not the insurance companies fault, this was my docs coordinators fault. She never sent all the info in, and finally I sent it in myself because she was being so difficult. Once I got the info to them, I was approved within 5 days. They work fast, just make sure that they have everything they need.

Nutrition eval

Psych eval (it needs to be pretty in depth)

5 year weight history

Follow up plan from your surgeon

There was no required pre op diet. My surgeon required one, but only to shrink my liver. BCBS has been fantastic about this whole thing once they got my info. Make sure you see what the doctor sends, and make sure it's all there.

Thanks for that info. Was your BMI close to being under 40, and did you have any other medical problems?

UPDATE................. Ok all, I finally went to my first appt with my PP. I would say it went rather well, I was sort of worried about my BMI being too low, but I hit that 40 on the head. I got my blood work all done today, I'm waiting for an appt for a bone density test, which is required for women my age. My PP talked a good game today, she was all for me having this done, she said once the results are all back she will have the letter prepared and ready to send to my surgeon. I am sooooooo excited! Pray that my insurance BCBS of NC will approve me on the first go round. I am ready to lose all this extra weight. I'm ready for a new start. I'll keep you all updated with the progress, how long it's taking etc. Thanks for all your support and keep me in prayer.

I saw the dr, nutritionist, trainer, and the psych, the dr.'s office was to turn in my paper work, within 2 weeks I got the call from them that I was approved, 1st dr visit 12-23-08, surgery on 3-4-09! I have BCBS state health plan, LOVE them! I am 5"1' and weighed around 206 at my dr visit, I was wearing a size 22, and this morning was able to button some old size 16's~

Did you have any major medical problems that helped the approval process? Congrats on your weight loss thus far. Keep it up.

Did you have any major medical problems that helped the approval process? Congrats on your weight loss thus far. Keep it up.

Ok, question. I went to the lapband orientation, I was weighed and my bmi was 39. something, my insurance co requires atleast a 40 bmi. Now, I have a Dr's appt on tomorrow (Monday) with my PP. If she agrees that the lapband will work for me, I then go to my lapband surgeon for the rest. Well, my question is I do have atleast a 5 year weight history, along with ww and adkins diet, mayo client etc. I bet I probably gained since the orientation a couple weeks ago which will bring my BMI up to atleast 40. Do you think that would put me at a better chance of getting approved through my insurance co?

Ok, all that have bcbs of north carolina. Approx how long does it take to get an approval from your insurance co. I know that there is a process I have to initially go through with my PD and the surgeon who's gonna do the banding, but I was informed that the longest wait is on the insurance co. Is there anyone with bcbs of nc that know?

Thanks

Personally, I would go to Duke first. If you go to a doctor and are turned down the first time, my suggestion is to contact obesitylaw.com and talk to Walter. This was my plan but dr. Enochs staff refused to cooperate. Allergan, the makers of the lapband, have a program that pays his fees if you are accepted. Walter states he has a good record with BCBS of NC.

So, before you were approved through Duke, did they diagnose you with sleep apnea or was it after you were approved. Ok, I live in Fayettevile, but work in Raleigh, can you give me a little more info on Duke, who can I contact to begin the process.

I have BCBS of NC. I was just banded April 6th. BMI about 40 with PCOS, High BP etc.

They do want to see 5 years of weight history from your Dr. I had no problem getting approved because of my comorbitities. Your Dr. will give you a good idea if you will be approved or not when you make your first appointment.

Good luck, give it a shot and see what happens! Let us know how it goes!

Thanks for the uplifting, I actually have a Dr's appt on Monday. I let you know how it goes.

They changed my surgery date to July 13 so im am no longer getting it in May. Man I cant wait.:thumbdown:

Don't be upset, thank God you are getting banded. I wish I can get banded, pray for me. I'm not quite at 40, I'm at 39, and my insurance require a solid 40. I can't afford to pay on my own. Good luck and keep us posted.

I was in the same boat. I had a BMI of 39, did not have a 5 year history because I worked my tail off for a year in a dr. supervised program, had terrible knees (need replacement). The first dr. I went to, Dr. enochs, I did not qualify for the insurance The appeal became such a problem with Dr. Enochs office, I switched to Duke. Dr. Enochs kindly gave me my initial fee back, BTW. I had my first appt. at Duke on 12/22, labs on 12/29, and was approved 12/31. all with the same information. I was banded on 2/19 and have lost 30 pounds. During the med. eval. at Duke, they found out I had sleep apnea. As it turned out , I did have a comorbidity. For NCBCBS, you do not have to have a 6 month diet. You do have to have a 5 year history. Joint pain does not count as a co-morbidity. I think a lot has to do with how the initial info. is presented to the insurance. JMO

Thanks Skep, that was sort of comforting. So, do you think if I'm turned down to switch Doc's. I know I don't have any major med problems, just obesity. This has gone on too long and I am desperate. Do you have any pics? You keep up the good work and I'm glad your were approved.