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Blue Shield Of California Ppo

helleva

By helleva, in Insurance & Financing

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Trcyprkr70    69

Trcyprkr70
Posted

So do I Denise.... I have some things that I need to get under my belt and I need this out of the way so I can get adjusted. KiKi my bmi is 39 and I have diabetes and high blood pressure. I'm 5'6 and weight 250. I hope mind come back soon. I have picked up 25 lbs in the last six months after losing close to 30 lbs. I just want to get the weight off and keep it off. Hope to get off the meds. The insurance paid for everything and approved right away, except for the psychologist I paid for out of pocket. I was mainly waiting for appointments. So KiKi do you have a date yet?

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helleva    22

helleva
Posted

Kiki,

Thanks for the response. I had gestational diabetes along with sleep apnea. Glad you were approved :) did they contact you or did you call the insurance the next day?

Thanks,

Denise

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kiki79    2

kiki79
Posted

My insurance company called me before the doctors office called. Good luck, I am sure you will be approved. :)

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Trcyprkr70    69

Trcyprkr70
Posted

Well good for you keep us posted. Wish you the best.

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helleva    22

helleva
Posted

thanks for the good hope and info.. thats awesome your having your surgery soon :) yes, please keep us posted!

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helleva    22

helleva
Posted

Hi,

I was just told that I have been denied! :( I'm so disappointed!! My coordinator I going to try and set a peer to peer and if not she will have to appeal. Just thought I'd update.

Thanks,

Denise

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SV2    57

SV2
Posted

Hi' date='

I was just told that I have been denied! :( I'm so disappointed!! My coordinator I going to try and set a peer to peer and if not she will have to appeal. Just thought I'd update.

Thanks,

Denise[/quote']

Damn!!

What was the reason given for the denial?

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helleva    22

helleva
Posted

Hi,

The reason was "not medical necessary". I don't understand. I had gestational diabetes, only have one kidney, and I have sleep apnea. I have been over weight most of my life. My father had diabetes, high blood pressure, renoplasty (spelled wrong but can lose his eye sight at any time from diabetes), kidney failure, and more from being over weight. My doctor for the past 11yrs. Recommended this procedure because he's seen my struggles and knows I'm headed down the same road as my father. I'm so sad and disappointed :(

Thanks for responding,

Denise :)

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SV2    57

SV2
Posted

Hi' date='

The reason was "not medical necessary". I don't understand. I had gestational diabetes, only have one kidney, and I have sleep apnea. I have been over weight most of my life. My father had diabetes, high blood pressure, renoplasty (spelled wrong but can lose his eye sight at any time from diabetes), kidney failure, and more from being over weight. My doctor for the past 11yrs. Recommended this procedure because he's seen my struggles and knows I'm headed down the same road as my father. I'm so sad and disappointed :(

Thanks for responding,

Denise :)[/quote']

Gotcha.

Damn... Don't give up.

I am also a low BMI patient (just over 35), with few comorbidities. The main thing for me is that my lapband has slipped, and needs to be removed. I was hoping to have a band to sleeve revision. Maybe the insurance will figure that since the surgeon will be in there anyway, he might as well sleeve me...

I've been told BCBS PPO is among the easiest to get approved, but maybe not.

Keep us informed as to what's going on.

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helleva    22

helleva
Posted

Hey,

I heard the exact same thing about my bcbs. I think it just depends because a lady on here had gestational diabetes and was approved just with that alone. Thanks, I don't plan on giving up. I'm hoping my physician and/or coordinator will fight with me. They really thought I was going to get approved first time around. I wish you lots of luck. It makes sense to do the procedure well taking out the band. Keep me posted :) and thanks again for responding to my post!

Denise :)

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SV2    57

SV2
Posted

Hey' date='

I heard the exact same thing about my bcbs. I think it just depends because a lady on here had gestational diabetes and was approved just with that alone. Thanks, I don't plan on giving up. I'm hoping my physician and/or coordinator will fight with me. They really thought I was going to get approved first time around. I wish you lots of luck. It makes sense to do the procedure well taking out the band. Keep me posted :) and thanks again for responding to my post!

Denise :)[/quote']

Absolutely!

We're in this together.

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Trcyprkr70    69

Trcyprkr70
Posted

Helleva, sorry to hear that, now I'm worried. Its been just over a week since my papers was submitted and I haven't heard anything. Hopefully they will get you approved soon. I don't know why some people get approved and others don't. I have so much aniexty right now.

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helleva    22

helleva
Posted

Oh gosh I know! Its so nerve wrecking :( I had so much hope reading others approvals. I don't get it. Thought I'd be approved. I waited 5 days then I called my insurance. I didn't get the denial until today though. I really hope you get approved :) please keep me posted on your situation. Best of luck!

Denise

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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      CaseyP1011

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    • KimBaxleyWilson

      KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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