Hi Everyone,

I just wanted to share with you all that I've finally got a surgery date of July 24. After a year of waiting lists,testing and jumping through hoops, It's finally my turn. The only thing that makes me worry now is that my insurance company (BCBS of Ma) has new guidelines stating that if your BMI is under 40 with 2 co-morbid diseases, they do NOT have to cover you unless the diseases are to the very extreme, meaning you could die if you didn't lose weight right away. BUT my Dr. is pretty sure I'm okay. My BMI is 39.8 with 2 co-morbid diseases but, I do have many other medical issues that would benefit me if I lost weight, so the Dr. thinks this is what will get me through.

Now don't get me wrong.. I know that the insurance company doesn't have to cover anyone. I'm just stating that they've changed the severity of the co-morbid disease.

Anyway, wish me luck. I'm told that the ins. comp. will inform me either way. I'm not sure how long it will take, but i'll be waiting by the phone. How long did it take for any of you to hear from them?

I had NGS American. My file was submitted on 2/8/06 and I got approval on 4/20/06. My psychologist had to re-submit his approval letter b/c insurance required specific wording even though it said I was recommended for surgery. Personally, I got the feeling my company was using delay tactics b/c they didn't want to pay. I hope you get a fast approval. A lot of people do. Let us know when you do get approval. It will be an exciting day for sure. :clap2:

I have researching the band for 2 years now. My first insurance company wouldn't cover my mother and i for the band, just gastric. because we wanted the band, we changed insurance companies in jan 06. I had already started the required 6 month diet in dec05, and finished the diet on may15, 2006.. turned in the paperwork by May 25, got approval on June 7th and got a date for July 5th.

Insurance will pay for 85%... My moms dates is June 26... monday! She also had no problems with the new insurance. She is going to change back to our old insurance next year because its cheaper.

After I received my surgery date they seem to act a lot quicker. Mine took about 2 additional weeks after I received the date. Hope this helps. Good luck.

My BMI was only 38 and UHC decided my co-morbities weren't life threatening enough so they denied me. I was beyond frustrated so I did what was best for me and went to Mexico and couldn't be happier. It took 2 1/2 weeks for me to find out. Good luck to you!!

~Liz~

banded 03/10/06

Dr.Ortiz

241/196/150

My BMI was over 48 and I had diabetes, plus heart and blood-pressure problems, so my approval took less than a month in 2002. Since then, however, my medical plan has removed bariatric surgery from it's list of covered surgeries.

My daughter-in-law's mother had to gain about 30 pounds to become eligible for her policy's approval.

Maybe one day, our disease will be treated like most other diseases.

Alcoholism, drug addiction, mental illness and morbid obesity are all treated as step-children in the medical insurance industry.

Thanks for all your input, I'll let you know how it goes for me. I just got off the phone with the Physicians Assistant and she says the clinic uses the same contact person at each insurance company, so it's usually pretty quick. Like some of you have said, if you have a date.. it's usually quicker. Let's hope! I changed my surgery date for the 27th of July. I'll have more help with the kids.

Good luck to everyone, I'll check in with you all soon to let you know what happened.

Time to love me-

Where are you getting your surgery done? I have BSBC MA and I didn't know they had changed anything. You can write me privately if you want.

I was very, very, VERY fortunate! I have Carefirst BlueCross and they approved me right away...they approved me within a month and a half. I met all their criteria and didn't have to postpone. I was very blessed.

I had to have all my paperwork submitted and approved before my doc. would even set my surgery date. I was approved by UHC in ten days, and was going to have my surgery 12 days after that but Gall Stones were found in my pre testing so we are getting that taken care of first (june 30th) then I will have my band done on july 25th... Hang in there, it will be APPROVED before you know it... Good luck

Leona, will your Mom be ok with having to pay for her own fills and such? will the old ins pay for complications she (knock on big piece of wood she wont) may have?

Diva, I sent you a PM. :eek:

I had to have all my paperwork submitted and approved before my doc. would even set my surgery date.

Jen, that is how I think every Dr. should do the process. That way it saves us the heartbreak of doing all the leg work, only to be denied for whatever reason. I would take a denial so much easier if I knew right away, rather than putting six months to a year into it, only to be denied later on.

Best of luck to everyone, I really hope the insurance people would treat this like any other disease.

I just sent my paperwork in today. The hospital I have chosen requires that you be pre-approved before setting a date. They said it usually takes 6 to 8 weeks to get approved and about two weeks after that is your surgery. So if all goes well I am looking at mid-August.

WOW.. I hope it doesn't take me 6- 8 weeks. I'll miss my surgery. I'm still liking the approval before they give you a date for surgery. Less stress!

Let us know how it goes!!

Time to love me-

Where are you getting your surgery done? I have BSBC MA and I didn't know they had changed anything. You can write me privately if you want.[/quote]

Diva,

I also have BSBC MA, and I didn't know they had changed anything. I have my consult with the surgeon at Brigham and Womens on July 6th. My BMI is only 35, but I do have medical problems since gaining so much weight over the last 6 years. I gained over 70 lbs, and it keeps going up. My cardiologist said that this surgery would be beneficial to me, he will work with surgeon at the hospital, only wants me to see this one surgeon since they know each other well and refer patients to one another. I'm so scared that I won't be approved. I have tried everything, even the hospital based diets, and I am on xenical right now, haven't lost anything in 2 months, feels like I gained weight. I can't go on other weight loss meds because of some heart issues I have, they won't prescribe it to me.

I had a sleep study done, I only had one episode of sleep apnea, but I had several of those other ones, can't remember what they are called. The recommendations were to lose weight or have surgery to stop the snoring, etc.

I'll be so depressed if I can't have this surgery done.

Let me know any information you have.

Thanks

Debbie