I'm trying to appeal to BCBS of Oklahoma for the lap band & am interested in BCBS's coverage of it in other states...anybody out there know???

I should have said BCBS of NC's policy for gastric banding is restricted to a max BMI of 50. Other BCBS policies may be entirely different.

I think that is a problem, everywhere. I had to fight BC/BS of CA to get my band due to my BMI being over 50.

If that is the only problem that you have in getting approved, e-mail me. I will send my letters and the research links.

Good Luck!!

BY THE WAY I HAVE A BMI OF 57, I HOPE I STILL QUALIFY IF I'M APPROVED..WE'LL SEE, THE JOURNEY BEGINS. THANKS FOR THE REPLIES!!

I have Empire BCBS Ny Direct HMO. Is there any way around the 6 month medically supervised diet? Does it have to be an MD to be considered medically supervised? I have been seeing a wellness Dr./chiropractor for over a year but I'm not sure if that would be acceptable? I'm a "do it now" person and the thought of 5 more months of waiting is agony.

I have a wonderful letter from my PCP, seen a cardiologist (EKG, Echo), pulmonologist, had a psych eval, esophogram, going for a nutrition consult next week. My PCP explained my past thyroid issues, gestational diabetes, and also listed me as having sleep apnea (never tested but chronic sleep issues). I was HOPING this would be enough but the concensus seems to be that the 6 month diet will be imperative.

Anyone think there is a chance I'll be approved without???

Thanks! I guess I need a cheerleader right about now!

-Jill in NY

Banded yesterday and sore as heck but very excited about my future!

Tracy

Omg!! Congrats on your surgery! I'm SO envious of you!!! Tell us all about it....how did it go? What's it like so far? How sore ARE you?? Etc, etc, etc. :clap2:

Omg!! Congrats on your surgery! I'm SO envious of you!!! Tell us all about it....how did it go? What's it like so far? How sore ARE you?? Etc, etc, etc. :clap2:

I'm starting to feel ALL of it. Like for the most part it's just been a sore throat and neck and port area. but now i'm starting to feel like I have been beaten up. REally feeling all the incisions and the 'diggin around' they must have done during surgery. I give a pretty detailed account in my journal listed under synicalchick. Probably more than anyone wants to know... :nervous I am happy to say that I haven't had any severe gas problems as of yet. I'll just be glad when I get past this really sore hurting point. I'm walking hunched over and stuff and sometimes my incisions feel like they are on fire.

Everyone keep up the fight and you to can be sore!

Tracy

I have Empire BCBS Ny Direct HMO. Is there any way around the 6 month medically supervised diet?

Thanks! I guess I need a cheerleader right about now!

This is the problem; the individual BCBS organizations make up their own rules. I shouldn't use the term "make up" I read the BCBS of NC policy and related studies...these folks did their homework. However, when it comes to making the "Corporate Policy for Surgery for Morbid Obesity" they all have their own slant on things. As an example, NC does not require "6 months of medically supervised diet." The do require proof that the insured has been morbidly obese for 4 out of the last 5 years. That was no big deal for me, I was obese in kindergarten. JB

I'm starting to feel ALL of it. Like for the most part it's just been a sore throat and neck and port area. but now i'm starting to feel like I have been beaten up. REally feeling all the incisions and the 'diggin around' they must have done during surgery. I give a pretty detailed account in my journal listed under synicalchick. Probably more than anyone wants to know... :nervous I am happy to say that I haven't had any severe gas problems as of yet. I'll just be glad when I get past this really sore hurting point. I'm walking hunched over and stuff and sometimes my incisions feel like they are on fire.

Everyone keep up the fight and you to can be sore!

Tracy

Just remember that each day will get better. Keep walking, even if you are hunched over, it will help get the anestsia out of your system. Drink plenty of fluids and try to get good rest at night. Don't be affraid to take the pain meds you were given. It is better to control the pain then to have to try and stop it once it gets bad. I took half doses of pain meds during the day and a full dose at night. I only needed pain meds for 2 days, and about 4 or 5 nights. It really will get easier, and you are on your way to a new, thin you. ~Mandy

TRACY, WHEN YOU SAY START PROCESS ON MY OWN???? MY DOCTOR HAS AKED ME IF I HAVE CONSIDERED GASTRIC BYPASS AND I TOLD HER AT ONE POINT I DID , BUT I FEEL IT IS JUST TO DRASTIC OF AN APPROACH. BESIDES MY CUZ HAD IT AND EVEN THOUGH SHE HAS LOST DRASTICALLY, SHE STILL HAS COMPLICATIONS MORE THAN NEED BE. SO, MY QUESTION IS....DO MY PRIMARY PHYSICIAN REFER ME, OR WHAT... I HAVE FOUND A SURGEON THROUGH THE LAP BAND SEMINAR I'VE BEEN TO. I CALLED THE INSURANCE CO AND THEY SAID THAT THEY DONT COVER ANY TYPE OF WEIGHT LOSS SURGERY. I SCHEDULED AN APPT TO MEET WITH THE SURGEON FOR AN EVAL AND IT IS $336.00. MY QUESTIONS IS DO I GO AND PAY OR WAIT FOR A REFERRAL FROM MY PRIMARY PHYSICHIAN. UUUUUUUUUUUUUUUGGGGGGGGGGHHHHHHHHHH!!!!! :help:

TRACY AND CONGRATS ON YOUR BAND, MANY MANY WELL WISHES 2 U!

TRACY, WHEN YOU SAY START PROCESS ON MY OWN???? MY DOCTOR HAS AKED ME IF I HAVE CONSIDERED GASTRIC BYPASS AND I TOLD HER AT ONE POINT I DID , BUT I FEEL IT IS JUST TO DRASTIC OF AN APPROACH. BESIDES MY CUZ HAD IT AND EVEN THOUGH SHE HAS LOST DRASTICALLY, SHE STILL HAS COMPLICATIONS MORE THAN NEED BE. SO, MY QUESTION IS....DO MY PRIMARY PHYSICIAN REFER ME, OR WHAT... I HAVE FOUND A SURGEON THROUGH THE LAP BAND SEMINAR I'VE BEEN TO. I CALLED THE INSURANCE CO AND THEY SAID THAT THEY DONT COVER ANY TYPE OF WEIGHT LOSS SURGERY. I SCHEDULED AN APPT TO MEET WITH THE SURGEON FOR AN EVAL AND IT IS $336.00. MY QUESTIONS IS DO I GO AND PAY OR WAIT FOR A REFERRAL FROM MY PRIMARY PHYSICHIAN. UUUUUUUUUUUUUUUGGGGGGGGGGHHHHHHHHHH!!!!! :help:

TRACY AND CONGRATS ON YOUR BAND, MANY MANY WELL WISHES 2 U!

The 1st thing I did was find a surgeon that was on the accepted list. YOu chould be able to get a book with a dr.'s list in it. THEN go to your primary care doctor to discuss getting banded. If they aren't in support of it.. get out your insurance book and find one that is. Here, with my surgeon I didn't have to be referred. I went to them 1st, got all the paper work that they needed from my general care dr, THEN I went to see my general dr. So. at this point.. have you found a surgeon on your isnurance list yet? If not.. do that, call them and make an appointment.. they will help you out the rest of the way.

hope this helps.

T

Walk, walk and more walking, it helps a lot.

I got up the nerve to get on he phone with a case manager at Empire BCBS. She was a bit confused why the "patient" and not the Dr was calling. I explained that I wanted to know the exact guidelines for Pre Approval. She was hesitant and a bit chilly at first, but I warmed her up (by explaining that I am a bit of a control freak). Well, she told me that the 6 month medically supervised diet is no longer a requirement! It apparently was at one time but lo longer.

I remained calm, but wanted to scream "HOORAY" into the phone. So, I've had the recommended EKG, Echocardiogram, Esophagram, Psych Eval, PCP visit and very encouraging letter and next week have the nutritional counseling as well as a pulmonary exam. I've listed each and every diet plan, cost, weight lost/regained. My bloodwork came back fine....slightly high cholesterol at 207 but nothing major. My BMI is 41. I'm hoping this will all be sufficient evidence for pre approval. I plan to fight for this one!

Thanks for your input...please send good karma my way!

Jill in NY

245/???/150

Dr. David Mayer

I got up the nerve to get on he phone with a case manager at Empire BCBS. She was a bit confused why the "patient" and not the Dr was calling. Well, she told me that the 6 month medically supervised diet is no longer a requirement! It apparently was at one time but lo longer.

Thanks for your input...please send good karma my way!

Jill in NY

245/???/150

Dr. David Mayer

The 6 months of medically supervised diet sure seemed like a bad idea. Glad they revised their policy. BTW, you have every right to call BCBS, it the gal was confused, that's her problem. Keep after them but don't argue or raise your voice. Calm, professional pressure.

Aren't karmas fattening? JB

i don't no i am trying to be good about it but it is hard and just trying was denied for the second time sent all diets and up and donw weight and still say not anuff send cruves boby by ivory nurtious info fo 7months so i wish someone could tell me when the6 month diet was not req anymore

Steady, even tempered not mad or upset. Stay cool and try to remember you will win

Your informaton says "10 cc band." I thought there were only two bands in the U.S. (and Mexico?), a 10 mm band and a VG(?) band? Something like that. The 10 mm means it's 10 mm around, but it only holds 4 ccs of saline, I think. Just curious.