Alisomniac

Denial was 100% from the medical group, spoke to Insurance today, (FED BCBS CA HMO) and said it sounded like I was easily approvable on paper based on BMI requirement, told me to call the medical group and discuss with them, if that doesnt work, call insurance to appeal or file a greivance, since I have some documentation .... here's what I have : 1 year of bank statements showing gym membership, 6-8 months subscription from Amazon for monthly Slim Fast shipments, a few scattered diet journal entries and weights, LONG list of exercise videos and diet books/magazines, health equipment purchases and a personal affidavit regarding the need for hte procedure. I also have blood test results stating that I am most likely insulin resistant. ... hopefully the appeal process goes smoothly.

Unfortunately I just got my denial letter today... so I am going through trying to put together an appeal and start on whatever requirements they are claiming I don't meet in the meantime. That way, if i get denied via appeal I will have the medical history necessary.

Just got the denial letter from insurance, stated I had not shown proof of past diets etc... even though I had given my history to my doctor... so now I'm formulating my appeal, contacting insurance and trying to figure out the next step. discouraging, but hopefully this actually makes ultimate approval easier. :biggrin:

My PCP says he faxed my referral in last Friday (BMI 44 - ick!), had have Fed BCBS CA HMO... hoping I hear back super soon! And that it is a POSITIVE response. I'm so ready for this, and every day I wake up fat, I am finding new reasons to want this change... it's like making this decision has opened my eyes to all the negatives I've introduced into my live because of my weight.

Hi! I just started with these forums, and in my own journey. I've been fat for a number of years (about 7), and before that overweight for 2-3 years and chubby since late childhood (about 10 years old). I'm currently 27 - nearly 28 and am beyond ready for the life change. Being fat feels like my life has been on hold, or even rewind at times, and I'm ready to be a healthy adult, where the daily indignities of being fat aren't ruling my life... the little things like being stared at in the grocery store or mall, or having a less than eventful romantic life. I saw my PCP (Family Doc) 3/29 and asked for a referral for WLS (Lap-Band; I'm not comfortable doing something that is not reversible). He sent me for a battery of blood tests the same day. My results will be posted in my stats. Stats: 5' 6.5" tall 280 pounds - 4/15/2010 (BMI 44-ish) Blood Pressure - 130/80 (mildly high) Blood Tests indicate Insulin Resistance/Pre-Diabetes 271.5 pounds - 4/28/2010 (BMI 43) Called the Doc today (4/28/2010) and he has yet to place the referral, but the front desk told me they'd take the message and he would call me back by the end of the week. My questions - some to him and some to y'all - 1. Does he refer me to a surgeon who will make a referral to insurance or does/can he make the referral directly? 2. What are my chances for approval? 3. What are the approval timelines from inital visit to insurance OK and surgery date? 4. What are the pre-op tests and hurdles to jump through? Are all of them mandatory? (Like the shrink and sleep studies) or are some optional or only for people who are borderline approvable? 5. How do you KNOW how much is the food limit? 6. What exactly can you eat in each of hte post-op phases? Is it really nothing but broth on the thin liquid phase? 7. How long until I can be back at work? are there any questions I should be asking? More about my situation: I have Federal Blue Cross/Blue Shield of California HMO. I live in Southern California. I am currently dieting on a modified South Beach Diet. I don't have a recorded or "official" diet history, but I have been dieting for the greater part of hte last 5 years... mostly SBD, and always plateauing at -20 lbs.... and it is nearly impossible, no matter how hard I diet and exercise to lose even that much. I do have a few FitDay - Free Weight Loss and Diet Journal diet journales, but am pretty spotty about keeping it up. (My hope is, barring any insurance snafus to get banded in August- when I turn 28 - unlikely I know - or by Thanksgiving at the latest ideal date. Do NOT want to wait until 2011.)