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I was all teed up to have my surgery in January only to learn at the last minute that it was not covered by my BCBS of NC. So, I had to cancel the surgery at the last minute and go through the appeals process. I'm happy to report that the appeal worked and I have since had the surgery-- just 4 months later. It was a big disappointment at the time, but, it all worked out. If you have to appeal, contact obesitylaw.com. They handled my appeal free-of-charge. It took them a little while--maybe a month or so, but, it was free.

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I have BC&BS of IL. they cover 80% if you have a BMI of 40 or above and a Dr. letter. They also want 5 years worth of weight records from your family physician and a good thyroid test. Hope this helps.

JP

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I have BCBS of Iowa anf we are preparing to submit to insurance either today or tomorrow.:faint: I have done all pre op testing and have found that my BMI is 46.2, I have sleep apnea, gerd/acidreflux, and I have completed yet another medically supervised diet. I have done supervised in the past but was told that BCBS of Iowa likes them to be done within 2 years prior to applying for surgery. My insurance plan does cover the surgery at 80/20 with an out of pocket max of $2,000 per year in which has been met with other appointments this year for other issues so the surgery would be 'free' :heh:. My question is this. With what I have told you about the co morbidities I have and my BMI do you think I will be approved? I know no one can give me the answer per say but I am asking for your opinions. I am just setting here restraining myself from phoning the insurance already and asking if they got the paperwork yet and what do they think-LOL I know I am being nerotic (sp?) now. Just wanted to hear others ideas on this.

BTW the surgeons office told me that BCBS is one of the easiest insurances to get to approve and to work with. Hope this proves true in my case as well as others.

Thanks for listening to me ramble. Now the wait begins-:frusty::phanvan

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I have BCBS of Iowa anf we are preparing to submit to insurance either today or tomorrow.:faint: I have done all pre op testing and have found that my BMI is 46.2, I have sleep apnea, gerd/acidreflux, and I have completed yet another medically supervised diet. I have done supervised in the past but was told that BCBS of Iowa likes them to be done within 2 years prior to applying for surgery. My insurance plan does cover the surgery at 80/20 with an out of pocket max of $2,000 per year in which has been met with other appointments this year for other issues so the surgery would be 'free' :heh:. My question is this. With what I have told you about the co morbidities I have and my BMI do you think I will be approved? I know no one can give me the answer per say but I am asking for your opinions. I am just setting here restraining myself from phoning the insurance already and asking if they got the paperwork yet and what do they think-LOL I know I am being nerotic (sp?) now. Just wanted to hear others ideas on this.

BTW the surgeons office told me that BCBS is one of the easiest insurances to get to approve and to work with. Hope this proves true in my case as well as others.

Thanks for listening to me ramble. Now the wait begins-:frusty::phanvan

I have federal bcbs and was approved the same day as my papers were submitted. My BMI was 54, with no co-morbidities.

good luck!!!

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Hi, Yes, I am having problems. I have been researching for 2 years and as of Jan. 2007, my insurance finally decided to join the band wagon of allowing the Lap band surgery.. REegence BCBS. Boy! was I excited!!!! I made the appointment for my seminar ( traveled 4 1/2 hours, spent a few days) and talked to the surgeon. He gave me paperwork to fill out, Got home and he accepted me as a patient. First thing he advised was to call my insurance company and see if it allows the surgery. Guess What? I have an Exclusion in my policy. So, here I am trying to find out what to do now. How can I even pay for all the testing they want if my insurance says they will not pay for anything to do with Obesity. Not even the testing. I am so disappointed and confused and feeling so hopeless. I do not know how to proceed from here.

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I have BC&BS of IL. I have been told they will cover 80% if you have a BMI over 40 a good thyroid test a psych. consult. I am still waiting my paper work was received on 5/23/07. It is in the reviewing process. God only knows how long this may take. Good luck to you.

JP

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I checked with BCBS of AL, which is the ins. that I have now, and as of April 28th, 2007, they will now cover lapband procedure and not just the by-pass provided that you follow the guidelines that they have set forth.

The main one seems to be going to an approved method of trying to lose weight for 6 consequtive months no less than one year prior to request for surgery. This can be 6 visits to your family physician, once per month documenting what you are doing, etc or to something like LA Weight Loss. It cannot be Weight Watchers, online weight loss sites, etc.

I am thankful that this has now been approved and that as long as I follow their guidelines (which are almost identical to the by-pass ones)

because I am about halfway thru the process now and am truly looking

forward to being able to have my surgery in the fall.

Please check with your BCBS provider and they can send you the new ruling dated April 28th, 2007.

Linda

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I am in Reno, NV. It took 8 weeks to get the approval and I had to travel to California for BCBS to approve it but I was approved on the first try.

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I have BC/BS of Illinois. I had to have 5 years of medical records, a psychiatric evaluation, sleep apnea study and 6 months worth of consistent supervised weight reduction proof. After I got all of that I needed, it was submitted to the insurance company and 6 days later I was called by the office and told I was approved. My insurance pays 100% which is unheard of but that's one of the perks of the company I work for. Thank goodness. I am scheduled for May 14th. I can't wait. It has been a long wait but well worth it.

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I had my lap aug 2007 started 243lbs now 165il and going for a fill this thrus and getting ready to start weight training email me at traceylemon@prodigy.net if have any questions:wink2::cry_smile::thumbup::crying:

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I have Empire BCBS. My BMI is 49 and I have mild sleep apnea. I was approved about 15 days after the surgeon's office submitted the request. My co-pay for the surgery is $250, in addition to co-pays for the surgeon, nutritionist and therapist.

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I've noticed people saying they check their insurance approval status for bariatric surgery online. Can anyone tell me how to do it? I have BCBS FEP.....

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    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 0 replies
      1. This update has no replies.
    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

    • 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. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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

        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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