Well, I was denied coverage today :thumbup:. I initially thought I would self pay, then was encouraged to submit to insurance, but I told myself I would self-pay if I was denied. Well........now they say a 3 month diet (my surgeon's staff thought that my 5 mos. of ww as well as all my other weight loss attempts might be enough to get it approved. They are not discounting that, but want to see proof of lifestyle change, nutritional counseling, exercise, behavior modification...ummm....how does ww provide proof of those things:confused:? I called my doctor's office and told them what was going one. They, of course, are familiar with this tactic (yes, I said tactic). She said she could count my initial consultation as the first visit, they booked me an appointment for tomorrow and will be conducting my supervised diet (giving me credit for one month already, I guess). I am so thrilled with their level of responsiveness and caring. Now I have to ask myself if waiting 2 more months is worth it. Yes, I have to say it is. Guess I will be starting my diet for real tomorrow. Since I'm right at a 40 bmi, they recommended that I did not lose any weight till my approval came through. My insurance company has assured me that they only consider the initial weight for this purpose. I know my doc's office is just being cautious as I'm sure they have seen it all. Feel like I have lucked out in a way...my insurance person that I've been speaking with is also waiting for lap band approval and has been above and beyond nice to me. She's giving me good advice on the whole process. I'm not looking at it as a big disappointment though (turn that frown upside down!)...Since I've been trying not to lose any weight, I've been treating every meal like the last supper and quite frankly I'm just over it! I gained a few more pounds in the process and I just want to start this phase of my life. If it begins with a three (two) month diet, minus the band, who cares? It's all weight that needs to come off. I know I can lose weight - just can't keep it off. I'm also considering taking phentermine to jump start everything. I was seeing a doctor last year who prescribed it (lost 25 lbs!) and as long as my surgeon is ok with it (I'll ask tomorrow at my appt.) I think I will go that route since I know there is an end in sight. Thanks for listening to my ramble...just had to vent!:thumbup:

i was not BC/BS, but my appproval flew through in part because I provided all of the journals from WW that I still had [i'm kind of a paper pack rat ], copies of my credit card statements for jenny craig meals and my gym memberships. Heck, I even photocopied my key ring with my gym and Curves member tag-card on it! LOL. Of course, not everyone she deals with had been "really" working on the issue for as long as that, as some decide surgery and then "build the record"...but in any event the paper proofs worked. The coordinator said she'd never sent a packed that big to my carrier before.

Perhaps you already have "evidence"...do you have gym memberships that you have canceled checks or credit card statements? WW? Jenny Craig? other weightloss purchases?

Good Luck. Try not to look at it as just a "tactic", everyone wants us to suceed..our doctors, our programs and even our carriers..albeit for different reasons. Ensuring that we are truly committed to the process and willing to expend effort, not just espouse good intentions is the way our carriers become satisfied we are doing what is best. After all, we are going to have make the same efforts after, so we may as well get a head start. [also known as "I choose to view things in a positive light"] No, I don't work for an insurance company...

I am sorry that you got your hopes up and now have to wait. It must be difficult to deal with in an already emotionally draining process. Hang in there, it sounds like your doctor will help guide you and in no time at all you will join the ranks of Bandster!

I did the 3 month BCBS required supervision. My doctor didn't demand that I lose weight but he did want me to make lifestyle changes each month that would make me more successful post op. I was miffed at first but really appreciated both the psych eval, where I was encouraged to really think about this choice and talk it out with the counselor, and the nutritionist, who helped me understand the relationship between the band and my future dietary choices. Between them all I felt much more in control, and have come to appreciate BCBS' requirements.

I totally get what you mean about appreciating the requirements...I'm starting to turn the corner on that as well. I think the initial frustration comes from years of battling this issue, years of dieting, gaining, and then having to prove "you've made an effort." It can initially seem condesending, even though it's not. I'm beginning to feel it's all about having the right attitude and not waiting for a surgery date to get your head into the whole process! It's about appreciating each step as important to the final goal

I've wondered what the docs thought about doing phentermine while you do your three month supervised diet. I have BCBS of Ill. and even though I did WW last summer, I didn't check in with my doctor each month so I am anticipating having to do the three month supervised diet. The only other times I have been "successful" with weight loss is when I was on the phentermine because I wasn't hungry! I'm hoping that the band will truly help curb my appetite. I can keep myself busy and occupied but its hard to concentrate when you are constantly hungry. Yesterday I had a pb and banana sandwich and I was still hungry.

I would pull your medical policy and read the requirements for approval. BC/BS requirements vary in each state. With my friends she had to have a BMI over 40 for a period of three years and be on a six month doctor supervised diet with no proof of weight loss. Mine required a BMI over 40 for a period of 5 years or a 35 BMI with one of 6 co-morbid conditions and a six month supervised weight loss proving that I could loose at least 5% of my initial body weight. They can all be tricky! Just a heads up...

I've wondered what the docs thought about doing phentermine while you do your three month supervised diet. I have BCBS of Ill. and even though I did WW last summer, I didn't check in with my doctor each month so I am anticipating having to do the three month supervised diet. The only other times I have been "successful" with weight loss is when I was on the phentermine because I wasn't hungry! I'm hoping that the band will truly help curb my appetite. I can keep myself busy and occupied but its hard to concentrate when you are constantly hungry. Yesterday I had a pb and banana sandwich and I was still hungry.

I just talked to my surgeon about that exact thing. I really wanted to do phentermine until surgery - just to get going on this journey! I saw another wls doc last year who prescribes it and lost 25 pounds pretty easily on it. 10 years ago I did phen-fen and lost ALL my weight on that. His answer was that he was not a big fan of the drug. He said he prescribes it for his patients that have to lose a significant amount of weight just to make the surgery even possible for them. I am at a 40 bmi and he flat out told me, "you don't need phentermine - you need the band." He was right. I have adjusted my attidude to do it on my own and not take the drug anymore (even though he told me I could go back to my other doc if I wanted to and get a prescription). I asked him if I did decide to take it, would it make surgery any more risky, meaning should I stop taking it 2 weeks before surgery, etc. He said I could take it the day before surgery and that would be ok, but his point was why take it and give yourself a heart attack when you are only 6 weeks away from surgery which is what you need anyway. He just didn't feel it was worth the health risk when I'm on track for getting banded. Makes sense to me now. It's my quest for immediate gratification that wants to take it!!! I'm impatient :confused:

2beskinny- Sorry I might have misspoken. My surgeons office told me that once my 3 month sup diet is met that i will be approved. Apparently we have very good insurance..she told me Fepblue Basic is one of the best out there. Im excited to get things going and 3 months will fly by..I have nothing better to do in the mean time i guess. Keep me updated and let me know how things are going with you. Id love to join you in your journey..sounds like we have a lot of the same issues going on.